Targeting metabolism in the management of PCOS: Metformin and beyond

Metabolic dysfunction, although not included in the diagnostic criteria, is very common in polycystic ovary syndrome (PCOS), especially in overweight/obese patients. Because metabolic disorders may not be as noticeable and/or disturbing as the other features of PCOS, it is important for physicians to inform and evaluate the patients in this regard. Insulin resistance and resulting hyperinsulinemia, which are aggravated by androgen excess, play a key role in several pathways leading to metabolic disorders such as glucose intolerance, diabetes and dyslipidemia. Lifestyle modifications including a healthy diet and regular exercise should be the main part of all intervention strategies targeting metabolic dysfunction in PCOS. Metformin is recommended in the treatment guidelines for overweight/obese PCOS, especially in patients with high metabolic risk. In line with recent advances in the treatment of hyperglycemia and/or obesity, newer agents targeting metabolic dysfunction in PCOS have become available. This chapter aims to provide up-to-date information about all the interventions targeting metabolism in PCOS.