When should an insulin sensitizing agent be used in the treatment of polycystic ovary syndrome?

Abstract

Polycystic ovary syndrome (PCOS) is associated with insulin resistance and an increased risk of developing type 2 diabetes mellitus. The attendant hyperinsulinaemia is also thought to contribute to the mechanism of anovulation in PCOS. Both metabolic and reproductive abnormalities are amplified by obesity and the treatment of first choice for overweight or obese women with PCOS is modification of diet and lifestyle. Nevertheless, changes in diet and exercise are, for many subjects, not easy to sustain and there seems an obvious place for insulin sensitizing agents in management of both reproductive and metabolic disturbances. Of the available agents affecting insulin sensitivity, metformin has been the most widely used but despite an enormous literature reporting beneficial effects on reproductive, cutaneous and metabolic manifestations of PCOS, its efficacy is unproven apart from in those subjects with impaired glucose tolerance or frank diabetes. Metformin at least has an assured safety record whereas both efficacy and safety of other insulin sensitizing agents in women of reproductive age, such as thiazolidinediones and glucagon-like peptide analogues, remains to be established. © 2011 Blackwell Publishing Ltd.