Conservative management of gynecologic diseases: insulin sensitizing agents in polycystic ovary syndrome

A contemporary "Pandora's box" could be the polycystic ovary syndrome (PCOS), containing several negative features for a woman: compromised looks, compromised fertility; increased metabolic risk factors; and compromised general health. During the past decade, the central importance of insulin resistance (IR) in the pathogenesis of this syndrome has been established. Several in vivo and in vitro studies have demonstrated this phenomenon, initially by the hyperinsulinemic response to oral glucose in obese and lean women with PCOS compared with weight-matched normal women, and subsequently with more sensitive techniques like euglycemic hyperinsulinemic clamp. In vitro studies have corroborated these findings, showing molecular defects at the postreceptor level of insulin action, such as increased serine phosphorylation and decreased phosphoinositol 3-kinase action. Insulin sensitizers are the group of therapeutic agents that hold some promise of helping women with polycystic ovary syndrome (PCOS), since the role of insulin resistance and hyperinsulinemia appear to be major contributors to the pathophysiology of the syndrome. The therapeutic approach with insulin sensitizers appears to have beneficial effects on the metabolic as well as on the reproductive abnormalities in women affected by PCOS. Finally, insulin sensitizers should be considered by all subspecialists who aim at a comprehensive management of patients with PCOS.