Summary

Polycystic ovary syndrome (PCOS) is common, under-diagnosed and a major public health concern and economic burden. In addition to reproductive features it is associated with psychological  and metabolic features and cardiovascular disease, and is in most cases underpinned by insulin resistance. Obesity exacerbates PCOS by increasing insulin resistance and hyperandrogenism. PCOS is a chronic disease, with manifestations across the lifespan, and is best managed using an interdisciplinary care model

Management should focus on support, education and addressing psychological factors and should have a strong emphasis on healthy lifestyle. Lifestyle management aiming for weight loss and/or prevention of weight gain should be first-line, with targeted medical therapy as required. Along with managing reproductive complications, monitoring for and managing longer-term metabolic complications (including glucose intolerance, diabetes, cardiovascular risk factors and hyperlipidaemia) is important. Consideration should also be given to screening family members for metabolic abnormalities.   

Key points

• PCOS is a chronic complex condition with psychological, reproductive and metabolic features.
• Women with PCOS have a high risk of metabolic syndrome, prediabetes and diabetes.
• Screening for metabolic features, including a lipid profile and an OGTT, is needed regularly to detect prediabetes when progression to diabetes is still preventable (fasting glucose levels are not adequate).
• Treatment for most patients is lifestyle focused and, while medical therapy can support ifestyle change, an aggressive lifestyle-based multidisciplinary approach is optimal in most cases to manage the features of PCOS and prevent long-term complications.
• Small achievable goals of 5% loss of body weight or moderate exercise three times a week results in significant clinical improvement even if women remain clinically in the overweight or obese range (BMI >25kg/m²).