Polycystic Ovary (Stein-Leventhal) Syndrome: Etiology, Complications, and Treatment

In those who do not desire to conceive and/or are not at risk for being pregnant, the administration of progesterone in the form of medoxyprogesterone acetate may be applied on a monthly basis.1,29 Progesterone will help decrease endometrial hyperplasia but will not decrease the level of ovarian androgens produced.1

Hyperinsulinemia was described as a hallmark for PCOS in 1981.31 However, investigation into the use of anti-hyperglycemic drugs in the treatment of PCOS did not occur for almost 15 years thereafter. Metformin (glucophage) is the best studied of the insulin-lowering drugs. Valazquez studied it first in 1994.32 The study involved 26 obese females who were placed on metformin for eight weeks. They reported a reduction in serum insulin levels as well as a 52% reduction in free testosterone. Studies have documented that lowering of insulin levels through the use of insulin-lowering drugs may ameliorate many of the abnormalities associated with PCOS including hyperandrogenism, irregular menstrual cycles, and ovulation irregularities, and potentially may effect a decrease in cardiovascular disease risk.

To date, approximately 10 authors have reported the beneficial effects of metformin in treating PCOS.33-41 The most recent study to demonstrate the long-term effectiveness of metformin treatment in obese women is by Moghetti, who used placebo and metformin in a group of 32 women.41 They found that the group receiving the insulin-lowering drug had significant improvement in the regularity of the menstrual cycle and ovulation, as well as a decrease in serum androgen and LH levels. These findings were maintained throughout a one-year monitored period. Although most studies have focused on obese women, Nestler and Jakubowicz administered metformin to lean PCOS women and established similar declines in hormonal abnormalities and the attending sequelae as those found in the obese subjects.33

Not all investigations of metformin have noted beneficial effects in the treatment of PCOS. Several studies noted no beneficial effect.42-45 Others involved morbidly obese subjects and the lack of effect may reflect the inability of the metformin to overcome the overwhelming androgen levels and hyperinsulinemia associated with morbid obesity regardless of PCOS status.

CONCLUSION

Polycystic ovary syndrome affects approximately 3% to 5% of the female population of reproductive age.2,5 It is the number one cause of infertility in women of the same age group. There have been many advances in our knowledge of the multi-factorial causes of PCOS and in our ability to treat the symptoms of the disease. However, because this syndrome presages health risks not limited to infertility, but extended to the cardiovascular system and cancer of reproductive organs, clinicians need to be alert to the potential existence, signs, and symptoms of PCOS in female patients of all age groups. Work to develop more specific laboratory and/or radiologic diagnostic markers for PCOS is needed.

This paper was written while Karri Lynn Hoyt was a student in the Duke University Physician Assistant Program.