From the Guidelines
The primary factors associated with Polycystic Ovary Syndrome (PCOS) are hormonal imbalances, insulin resistance, genetic predisposition, and lifestyle factors, with insulin resistance playing a crucial role in many symptoms of PCOS, as evident from the latest evidence 1.
Key Factors
- Hormonal imbalances, particularly elevated levels of androgens and luteinizing hormone (LH), are central to PCOS, leading to irregular ovulation and the development of ovarian cysts.
- Insulin resistance, present in both lean and overweight women with PCOS, contributes to hyperandrogenism through effects on the pituitary, liver, and ovaries, and is further exacerbated by obesity 1.
- Genetic factors play a role, as PCOS tends to run in families, suggesting a hereditary component.
- Lifestyle factors such as obesity, poor diet, and lack of physical activity can exacerbate PCOS symptoms and increase the risk of developing the condition.
Impact of Lifestyle Factors
- A systematic review and meta-analysis of 39,471 women found that women with PCOS often exhibit cardio-metabolic aberrations, including insulin resistance, dyslipidemia, and visceral adiposity, and are at risk for developing metabolic syndrome, type 2 diabetes, and sleep disturbance 1.
- Lifestyle modification or weight loss is postulated to improve many symptoms of PCOS, highlighting the importance of addressing lifestyle factors in the management of the condition 1.
Management Implications
- Understanding the factors associated with PCOS is crucial for developing effective treatment strategies, which may include hormonal medications, insulin-sensitizing drugs like metformin, dietary changes, and increased physical activity.
- The latest evidence-based guideline for the assessment and management of PCOS emphasizes the importance of lifestyle management, including weight loss and physical activity, in improving symptoms and reducing the risk of associated health problems 1.
From the Research
Factors Associated with Polycystic Ovary Syndrome (PCOS)
The factors associated with PCOS can be summarized as follows:
- Genetic factors: PCOS is determined by the association of multiple genetic factors, including gene polymorphisms that regulate ovarian steroidogenesis and insulin sensitivity 2
- Environmental factors: Socioeconomic and cultural factors that influence food quality and quantity, as well as energy expenditure, can contribute to the development of PCOS 2
- Hyperandrogenism: Clinical or laboratorial hyperandrogenism is a key feature of PCOS, and can lead to symptoms such as hirsutism, acne, and androgenetic alopecia 3, 4
- Insulin resistance: Insulin resistance is a common feature of PCOS, and can contribute to the development of metabolic abnormalities such as type II diabetes and dyslipidemia 5, 3, 4
- Obesity: Obesity, particularly visceral adiposity, can amplify and worsen metabolic and reproductive outcomes in PCOS, and is often associated with insulin resistance and hyperandrogenism 5, 4
- Neuro-endocrine and hypothalamic-pituitary dysfunction: PCOS has been linked to neuro-endocrine and hypothalamic-pituitary dysfunction, which can contribute to the development of hyperandrogenism and insulin resistance 5
Key Features of PCOS
The key features of PCOS include:
- Oligo-anovulation: Irregular menstrual cycles are a common feature of PCOS 3, 6
- Polycystic ovaries: The presence of polycystic ovaries on ultrasonography is a key diagnostic criterion for PCOS 3
- Hyperandrogenism: Clinical or laboratorial hyperandrogenism is a key feature of PCOS, and can lead to symptoms such as hirsutism and acne 3, 4
- Insulin resistance: Insulin resistance is a common feature of PCOS, and can contribute to the development of metabolic abnormalities such as type II diabetes and dyslipidemia 5, 3, 4
Diagnosis and Management of PCOS
The diagnosis of PCOS is primarily clinical, based on the presence of at least two of the three Rotterdam criteria: oligo-anovulation, hyperandrogenism, and polycystic ovaries on ultrasonography 3. Management of PCOS typically involves lifestyle modification, including caloric restriction and increased physical activity, as well as pharmacologic treatment to address symptoms such as hirsutism and acne 5, 3, 6.