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Review
. 2012 Dec;30(6):496-506.
doi: 10.1055/s-0032-1328878. Epub 2012 Oct 16.

Obesity and PCOS: implications for diagnosis and treatment

Richard S Legro  1
Affiliations
Review

Obesity and PCOS: implications for diagnosis and treatment

Richard S Legro. Semin Reprod Med. 2012 Dec.

Abstract

There appears to be an epidemic of both obesity and polycystic ovary syndrome (PCOS) in the world today. However, obesity per se is not a part of the phenotype in many parts of the world. Obesity is likely not a cause of PCOS, as the high prevalence of PCOS among relatively thin populations demonstrates. However, obesity does exacerbate many aspects of the phenotype, especially cardiovascular risk factors such as glucose intolerance and dyslipidemia. It is also associated with a poor response to infertility treatment and likely an increased risk for pregnancy complications in those women who do conceive. Although most treatments of obesity, with the exception of bariatric surgery, achieve modest reductions in weight and improvements in the PCOS phenotype, encouraging weight loss in the obese patient remains one of the front-line therapies. However, further studies are needed to identify the best treatments, and the role of lifestyle therapies in women of normal weight with PCOS is uncertain.

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Figures

Figure 1
Figure 1
Prevalence of polycystic ovary syndrome (PCOS) by body mass index (BMI) category in an unselected group of women applying for jobs at an academic health center in the southeastern United States. Adapted from Yildiz et al.
Figure 2
Figure 2
(A) Effects of troglitazone (TGZ) on circulating levels of fasting insulin, (B) testosterone, (C) sex hormone-binding globulin (SHBG) (all compared with baseline levels), and (D) the ovulation rate (number of [observed/expected] ovulations averaged for each treatment group). PLC, placebo. Note that there is no significant effect of increasing doses of TGZ on total testosterone; however, there are dose-related increases in body weight (data not shown). Adapted from Azziz et al.
Figure 3
Figure 3
Insulin sensitivity by diagnosis (polycystic ovary syndrome [PCOS]: purple bars; control women: blue bars) and weight group (lean versus obese) as determined by a frequently sampled intravenous glucose tolerance test. Adapted from Dunaif et al.
Figure 4
Figure 4
Prevalence of glucose intolerance (2-hour glucose level ≥140 mg/dL on 2-hour oral glucose tolerance test) by body mass index (BMI) category in women with polycystic ovary syndrome (PCOS) from academic health centers in urban and suburban settings in the United States. Adapted from Legro et al.
Figure 5
Figure 5
A baseline model for chance of live birth with up to 6 months of therapy with clomiphene citrate in women with polycystic ovary syndrome (PCOS) using age, duration of infertility treatment, body mass index (BMI), and degree of hirsutism on Ferriman-Gallwey assessment. Adapted from Rausch et al.
See this image and copyright information in PMC

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