"Hum Reprod 2002 Aug;17(8):1950-3 (ISSN: 0268-1161)
Nestler JE
Division of Endocrinology and Metabolism, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23298, USA. E-mail: nestler~hsc.vcu.edu.
Insulin resistance is a prominent feature of polycystic ovarian syndrome (PCOS), and women with the disorder are at increased risk for the development of other diseases that have been linked to insulin resistance-namely, type 2 diabetes and cardiovascular disease. This association between insulin resistance and PCOS must guide the chronic management of the disorder, and accumulating evidence suggests that administration of insulin-sensitizing drugs to individuals at high risk for type 2 diabetes decreases the rate of conversion to overt disease. In contrast, limited evidence exists to suggest that oral contraceptive pills-the currently standard therapy for PCOS-may actually decrease insulin sensitivity and induce impaired glucose tolerance in women with PCOS. Hence, PCOS should be regarded as a general health issue and the use of insulin-sensitizing drugs such as metformin should be considered for the prevention of type 2 diabetes>"
The important point, IMHO, is that PCO is most likely a variant and manifestaion of insluin resistance. These disorders also described as; syndrome X, metabolic syndrome, and metabolic disease X, are now being recognized by physicians as a probable etiology for many diseases of Western society such as diabetes, HBP, heart disease, and obesity. They seem also to be very much an epidemic releated to our diet of refined and glycemic carbohydrates. Diet guru's who have promoted all forms of carbohydrates at the expense of fats and protiens now are being forced to rethink their previous postitions. Physicians did not treat PCO well in the past because the true etiology (insulin resistance) was not understood. Therefore treatments consisted of symptomatic (regluate menses with OCP's, weight loss, treatments for hirsuitism ) rather than treating the most likely cause of insulin resistance. (The same may also be said for other manifestataions of insulin resistance such as diabetes, HBP, heart disease and obesity.) I predict that we will see much better treatments for diseases of insulin resistance, now that there is better physician education on this disorder. Sadly, some physicians will not accept new information, and patients may miss promising new treatment.