Polycystic ovary syndrome: A review of diagnosis and management, with special focus on atherosclerotic cardiovascular disease prevention

• Published in: Journal of clinical lipidology Vol. 18; no. 4; pp. e488 - e500
• Main Authors: Myerson, Merle L., Paparodis, Rodis D, Block, Robert C., Karalis, Dean G., Mintz, Guy, Brinton, Eliot A., Wild, Robert
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2024
• Subjects: Androgen excess; Atherosclerosis - diagnosis; Atherosclerosis - prevention & control; Atherosclerosis - therapy; Atherosclerotic cardiovascular disease; Cardiometabolic disease; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - prevention & control; Female; Humans; Infertility; Lifespan; Metabolic syndrome; Obesity; Oligomenorrhea; PCOS; Polycystic Ovary Syndrome - complications; Polycystic Ovary Syndrome - diagnosis; Polycystic Ovary Syndrome - therapy; Cardiometabolic disease; Obesity; PCOS; Atherosclerotic cardiovascular disease; Infertility; Androgen excess; Oligomenorrhea; Metabolic syndrome; Lifespan
• ISSN: 1933-2874
• DOI: 10.1016/j.jacl.2024.04.131

•Polycystic ovary syndrome (PCOS) is common worldwide. The syndrome refers to a group of disorders with multiple reproductive, metabolic, and endocrine elements.•PCOS affects women from fetal life throughout their lifespan, often decreasing reproductive ability and quality of life, and increasing other types of morbidity and mortality. It is often undiagnosed and untreated.•Management traditionally focuses on the treatment of hyperandrogenism and oligomenorrhea. Women with PCOS often have dyslipidemia, hypertension, obesity, and metabolic syndrome. Management plans should incorporate diagnosis and management of these factors, if present, because of the strong contribution to risk for atherosclerotic cardiovascular disease.•Understanding that the disease extends throughout life emphasizes the importance of continued screening for and treatment of risk factors to prevent cardiovascular disease throughout a woman's lifespan.•Given the complexities of the syndrome and heterogeneous manifestations, optimal management often requires a multi-disciplinary approach to provide counseling and support for lifestyle modification and addressing the full range of any reproductive, endocrine, and cardiometabolic abnormalities. Polycystic ovary syndrome (PCOS) is a common endocrinopathy worldwide with a heterogeneous clinical presentation including reproductive, metabolic, and endocrine elements. However, the assessment and management of PCOS remains inconsistent, with many women undiagnosed and untreated. We now also understand that the management of PCOS should extend throughout a woman's lifespan as many elements of the syndrome persist after menopause. Management has traditionally focused on the treatment of hyperandrogenism and oligomenorrhea. Women with PCOS often have dyslipidemia, hypertension, obesity, and metabolic syndrome, which may be worsened by the hormonal abnormalities, and are therefore at higher risk for cardiovascular disease morbidity and mortality, a risk that increases after menopause. While treatment with hormonal therapy, in particular combined oral contraceptives, may improve cardiovascular risk factors, management plans should incorporate specific diagnosis and management of these factors, if present, because of the strong contribution to the risk for atherosclerotic cardiovascular disease. Given the complexities of the syndrome, optimal management often requires a multi-disciplinary approach including the lipid and cardiometabolic specialist to provide counseling and support for lifestyle modification along with pharmacologic therapy as indicated to address the full range of any reproductive, endocrine, and cardiometabolic abnormalities.