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POLYCYSTIC OVARY SYNDROME IN 2020

The importance of metabolic dysfunction in polycystic ovary syndrome

Nature Reviews Endocrinology volume 17, pages 77–78 (2021)Cite this article

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Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder characterized by reproductive and metabolic disturbances. Androgen excess is a hallmark of PCOS, driving many of the phenotypic features. In 2020, several findings highlight altered metabolic pathways as an underlying biological mechanism in PCOS. These findings add to our understanding of the complex interaction between metabolic homeostasis and reproduction.

Key advances

  • Polycystic ovary syndrome (PCOS) has genetically distinct reproductive and metabolic subtypes4.

  • A polygenic risk score-based phenome-wide association study has identified shared biological pathways between PCOS and obesity5.

  • Both the brain and adipose tissue are key tissues in the development of androgen-induced reproductive dysfunction in a mouse model of PCOS7.

  • Intranasal insulin administration improves the reduced adaptive thermogenesis in a sheep model of PCOS8.

  • Unfavourable changes in the diversity and composition of the gut microbiome are already present in adolescents with PCOS, independent of obesity9.

  • Changes in the dietary macronutrient balance improve reproductive dysfunction in a mouse model of PCOS, without beneficial effects on metabolic dysfunction10.

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in women of reproductive age, affecting 10–15% of women worldwide1. Based on the most recent international, evidence-based guidelines, PCOS is diagnosed by the Rotterdam criteria, which requires the presence of at least two of the following three criteria: hyperandrogenism (biochemical or clinical), ovulatory dysfunction (oligoovulation or anovulation) and polycystic ovary morphology2. PCOS is divided into four main phenotypes based on combinations of these three diagnostic criteria. Furthermore, although initially considered a reproductive disorder, it has become evident that PCOS is a multisystem endocrine disorder. In addition to infertility, women with PCOS also often have obesity and insulin resistance, and therefore have an increased risk of cardiovascular disease, nonalcoholic fatty liver disease and type 2 diabetes mellitus1. PCOS is a very heterogeneous disease, which might have contributed to the fact that, despite its high prevalence, the aetiology is still poorly understood. In 2020, several studies have been published that further our insight into the underlying pathophysiology of PCOS.

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Authors and Affiliations

  1. Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands

    Jenny A. Visser

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  1. Jenny A. Visser
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Correspondence to Jenny A. Visser.

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The author declares no competing interests.

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Visser, J.A. The importance of metabolic dysfunction in polycystic ovary syndrome. Nat Rev Endocrinol 17, 77–78 (2021). https://doi.org/10.1038/s41574-020-00456-z

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