PCOS as A Metabolic Disease

Abstract

Background: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder, affecting 6–20% of women of reproductive age. It has evolved from being perceived solely as a reproductive disorder to being recognized as a complex metabolic disease. Multiple factors contribute to its pathogenesis, including insulin resistance, hyperandrogenism, obesity, chronic low-grade inflammation, and genetic, epigenetic, and environmental influences. The interplay of these factors increases the risk of type 2 diabetes, cardiovascular disease, and other comorbidities, highlighting the metabolic nature of PCOS.

Methods and Materials: This study involved a comprehensive literature review of recent peer-reviewed articles, meta-analyses, and clinical guidelines related to the metabolic aspects of PCOS. Emphasis was placed on pathophysiological mechanisms such as insulin resistance, obesity, dyslipidemia, NAFLD, hypertension, and the role of endocrine disruptors and epigenetic modifications. Additionally, therapeutic approaches, including lifestyle modifications, pharmacological interventions, and surgical options, were evaluated to illustrate current management strategies for PCOS as a metabolic condition.

Results: The findings reinforce that insulin resistance is present in 50–70% of women with PCOS, often leading to compensatory hyperinsulinemia and elevated androgen levels. Obesity exacerbates these metabolic derangements and increases the risk of comorbidities like type 2 diabetes, cardiovascular diseases, and NAFLD. The review also highlights the impact of inflammation, dyslipidemia, and hypertension, which collectively contribute to the metabolic syndrome profile observed in PCOS patients. Evidence suggests that lifestyle interventions, anti-diabetic medications, hormonal therapies, and targeted supplements can significantly improve metabolic and reproductive outcomes.

Conclusion: PCOS should be approached as a metabolic disease due to its strong association with insulin resistance, obesity, and other metabolic complications. Recognizing this helps optimize prevention and management strategies, which should combine lifestyle interventions, pharmacological treatments, and patient education. An individualized, multidisciplinary approach can reduce long-term risks and improve the quality of life for women with PCOS.