Complications and challenges associated with polycystic ovary syndrome: current perspectives

Figures & data

Table 2 Summary of recommendations for clinical assessment and treatment of long-term PCOS complications

Management of long-term complications
	Clinical assessment	Therapeutic approaches
Metabolic risk	Screening for impaired glucose tolerance and T2DM with 75 g OGTT in PCOS women with:	Lifestyle change programs (hypocaloric diet and physical exercise) represent the first-line approach for obese PCOS women
	– age >40 years
	– BMI >30	Metformin use for prevention of diabetes in PCOS women with impaired glucose tolerance when lifestyle modification is not successful and/or as an adjuvant to general lifestyle modifications
	– classic phenotype
	– presence of achantosis nigricans
	– personal and/or family history of T2DM
	BMI and waist circumference at every visit:	Thiazolidinediones as alternative therapy in insulin-resistant, obese PCOS patients who are intolerant or refractory to metformin, or with severe insulin resistance due to genetic disorder
	– waist circumference >80 cm
	– abdominal obesity
	Periodic reassessment with OGTT
Cardiovascular risk	CVD risk assessment at any age with:	Lifestyle modification:
	– blood pressure	– diet
	– lipid profle	– physical exercise
	– waist circumference	– smoking cessation
	– BMI	Metformin use for prevention of T2DM in PCOS women with impaired glucose tolerance when lifestyle modification is not successful and/or as an adjuvant to general lifestyle modifications
	– glucose profile
	– cigarette smoking
	– family history of early CVD
	– evaluation for depression, anxiety, and quality-of-life	Statins to lower LDL-C levels
	Categorize PCOS patients as “at risk” for CVD if present:	Antihypertensive drugs
	– obesity
	– hypertension
	– dyslipidemia
	– cigarette smoking
	– subclinical vascular disease
	– impaired glucose tolerance
	– family history of premature CVD
	Categorize PCOS patients as “at high risk” for CVD if present:
	– metabolic syndrome
	– T2DM
	– vascular and/or renal disease
	Periodic clinical reassessment
Oncological risk	In presence of amenorrhoic patients or abnormal uterine bleeding, assessment for the presence of endometrial cancer with ultrasound and/or endometrial biopsy	Periodic progestogen withdrawal (at least four episodes per year) should be indicated in anovulatory PCOS women

Abbreviations: CVD, cardiovascular disease; OGTT, oral glucose tolerance test; PCOS, polycystic ovary syndrome; LDL-C, low-density lipoprotein cholesterol; BMI, body mass index; T2DM, type-2 diabetes mellitus.

Table 1 Summary of recommendations for the management of infertility in oligoanovulatory women with PCOS

Management of early complications
Lifestyle modification (diet and physical activity)	First-line nonpharmacologic approach to treat obese/overweight oligoanovulatory PCOS patients
Clomiphene citrate	First-line treatment of ovulatory infertility in women with PCOS
Letrozole	Potential first-line treatment of ovulatory infertility but it is still off-label drug not recommended in clinical practice
Metformin	Treatment of choice as clomiphene citrate sensitizing and as adjuvant therapy to prevent OHSS in PCOS women undergoing IVF cycle, but it is still off-label drug
Laparoscopic ovarian drilling	Indicated in well-selected cases of oligoanovulatory PCOS women who need laparoscopic assessment of the pelvis
Gonadotropins	Considered last treatment option in PCOS population for high costs, high risk of multiple pregnancies, and OHSS

Abbreviations: IVF, in vitro fertilization; OHSS, ovarian hyperstimulation syndrome; PCOS, polycystic ovary syndrome.