Abstract
Women with polycystic ovary syndrome come to the gynecologist with a variety of symptoms,
including menstrual irregularities, hirsutism, acne, weight gain, obesity, and infertility.
An accurate diagnosis requires both confirmation of signs and symptoms of polycystic
ovary syndrome and exclusion of other disorders. Once the diagnosis of polycystic
ovary syndrome has been established, the presence of concomitant conditions, such
as hypertension, dyslipidemia, and diabetes, must be assessed. Because the cause of
polycystic ovary syndrome is not clear, treatment options have focused on symptom
management. Such treatment options include oral contraceptives, gonadotropin-releasing
hormone analogs with “add-back” hormone regimens, antiandrogens, ovulation-inducing
agents, electrolysis, nutritional and weight loss counseling, exercise, laparoscopic
ovarian drilling, and glucocorticoids. Pathogenic considerations, risk factor assessments,
and treatment objectives combine to determine the choice of therapies. It is not clear
whether insulin resistance is clinically important or causal in polycystic ovary syndrome
symptom complex in all affected women. Polycystic ovary syndrome may be the final
common expression of a variety of metabolic or neuroendocrine perturbations. If insulin
resistance is a universal feature, it would make sense to treat with an insulin-sensitizing
agent in the expectation that symptoms would resolve or improve. If insulin resistance
is not the main etiologic factor, however, then insulin-sensitizing agents would be
useful as adjunctive agents only for women with clinically important insulin resistance
(eg, patients with polycystic ovary syndrome in whom insulin resistance causes hyperglycemia).
In such cases an insulin-sensitizing agent could be instituted along with a program
of weight loss and exercise. (Am J Obstet Gynecol 1998;179:S109-13.)
Keywords
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Article info
Footnotes
☆Reprint requests: Sarah L. Berga, MD, The University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket St, Pittsburgh, PA 15213.
☆☆0002-9378/98 $5.00 + 06/0/94972
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Copyright
© 1998 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
