Highlights From The First World Congress on the Insulin Resistance Syndrome

Zachary T. Bloomgarden, MD

Disclosures

January 29, 2004

In This Article

Association Between the IRS and the PCOS

John E. Nestler, MD, Virginia Commonwealth University, noted that the syndrome of chronic anovulation and hyperandrogenism affects 6% to 10% of women of childbearing age, and causes 50% to 60% of female infertility due to anovulation.[51] Most, if not all, of these women have insulin resistance. In a Cochrane meta-analysis,[52] metformin monotherapy improved the ovulation rate 3.9-fold over placebo, and the combination of metformin and clomiphene improved both ovulation and pregnancy rates 4.4-fold over clomiphene alone. PCOS is associated with a 30% to 50% rate of early pregnancy loss. A comparison of 68 women treated with metformin during pregnancy vs 31 not treated with metformin showed early pregnancy loss in 9% vs 42%.[53]

General health risks for women with PCOS may be affected by their insulin resistance. Women with PCOS have a 30% prevalence of IGT and a 10% prevalence of diabetes.[54] In the Nurses Health Study, oligomenorrheic women had a 2-fold higher rate of conversion to type 2 diabetes.[55] Conversely, 25% to 28% of women with type 2 diabetes have evidence of PCOS.[56] A retrospective study of Swedish women who had ovarian wedge resection in the 1950s showed they had a 7.4-fold risk of myocardial infarction.[57] Women who had undergone cardiac catheterization showed an association between polycystic ovaries on ultrasound and the extent of coronary artery disease.[58] Furthermore, oral contraceptives may worsen insulin sensitivity,[59] may cause glucose intolerance,[60,61] may increase triglyceride levels, and may increase CVD risk, according to various studies. Insulin sensitizers may decrease CVD risk, so these appear to be the preferred agents for long-term treatment.

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