Mechanisms and treatment of obesity in polycystic ovary syndrome

The polycystic ovary syndrome (PCOS), one of the most common causes of infertility because of anovulation, affects 4-7% of women. Intriguingly, obesity has an important pathophysiological impact on PCOS, and obese PCOS women are characterized by worsened endocrine and metabolic profiles and poorer fertility. Although it is believed that obesity simply emphasizes most common alterations such as hyperandrogenism and the insulin-resistant state, it is nonetheless likely that the obesity-PCOS phenotype represents a heterogeneous group of women with different pathophysiological events. In our opinion, this represents an exciting area for future research. Whatever the mechanisms, treatment with lifestyle interventional programs has clearly demonstrated its efficacy in obese PCOS women. Unfortunately, this approach is probably underestimated by many physicians. This is probably because of the well-known and considerable difficulties in the management of obesity and related disorders. The recognition that many benefits can be achieved even in the short term may however improve patient compliance. In fact, in many patients, there is no need to achieve an impressive weight loss to improve menses, ovulation, and therefore fertility. There is however the need for lifestyle interventional programs targeted to women affected by PCOS. The long story of metformin in PCOS seems to demonstrate that by reducing insulin a great benefit can be achieved regardless of minor changes in body weight. These and others represent excellent opportunities for future research in the field of PCOS.