Polycystic ovarian syndrome and insulin resistance: implications for estrogen use in premenopausal and postmenopausal women.
Polycystic ovarian syndrome (PCOS) is the most frequent endocrine\ndisorder of reproductive age women, affecting an estimated 8-10%\nof all women in this age group or approximately six million women.\nFurther, women with PCOS continue to manifest the metabolic alterations\ninherent in the insulin resistance syndrome after menopause, rendering\nthem more susceptible to type 2 diabetes and cardiovascular disease.\nAging and obesity further contribute to these risks. Since estrogen-containing\ntherapy is commonly used for menstrual regulation in premenopausal\nwomen with PCOS, it is important to evaluate the possible consequences\nof hormonal therapy on subsequent metabolic and cardiovascular risk.\nIn postmenopausal women, a consensus regarding the appropriate role\nof estrogen replacement therapy is currently in evolution. By examining\nthe effects of estrogen with or without progesterone on insulin resistance,\ninsight may be gained about the risk/benefit ratio of this therapy\nin the subset of women with insulin resistance, PCOS, and type 2\ndiabetes. The goal of this review, then, is to examine the known\neffects of estrogen on insulin sensitivity and its implications for\ncardiovascular and metabolic risk.