Polycystic ovary syndrome (PCOS) is a chronic condition. There is no cure. Thus, management options are targeted at alleviating the signs and symptoms to reduce morbidity. Another goal of treatment is to prevent the development of complications such as type 2 diabetes and cardiovascular disease in later life.[188]Wenger NK, Lloyd-Jones DM, Elkind MSV, et al. Call to action for cardiovascular disease in women: epidemiology, awareness, access, and delivery of equitable health care: a presidential advisory from the American Heart Association. Circulation. 2022 Jun 7;145(23):e1059-71.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001071
http://www.ncbi.nlm.nih.gov/pubmed/35531777?tool=bestpractice.com
There have been no clinical trials demonstrating the efficacy of any agent in terms of preventing complications. Many experts believe that weight loss and metformin may prevent diabetes and atherosclerosis.[189]Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.
http://www.nejm.org/doi/full/10.1056/NEJMoa012512#t=article
http://www.ncbi.nlm.nih.gov/pubmed/11832527?tool=bestpractice.com
[190]UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998 Sep 12;352(9131):854-65.
http://www.ncbi.nlm.nih.gov/pubmed/9742977?tool=bestpractice.com
In PCOS, therapy is generally continued throughout the reproductive years. If treatments are stopped during that time, symptoms generally recur. As women with PCOS get older or reach menopause, hyperandrogenic manifestations may improve as ovarian function declines, allowing withdrawal of therapies directed against hyperandrogenism.[191]Pinola P, Piltonen TT, Puurunen J, et al. Androgen profile through life in women with polycystic ovary syndrome: a Nordic multicenter collaboration study. J Clin Endocrinol Metab. 2015 Sep;100(9):3400-7.
https://academic.oup.com/jcem/article/100/9/3400/2836076
http://www.ncbi.nlm.nih.gov/pubmed/26192874?tool=bestpractice.com
[192]Brown ZA, Louwers YV, Fong SL, et al. The phenotype of polycystic ovary syndrome ameliorates with aging. Fertil Steril. 2011 Nov;96(5):1259-65.
https://www.fertstert.org/article/S0015-0282(11)02501-5/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/21963227?tool=bestpractice.com
However, in some women with PCOS who enter menopause, clinical and biochemical hyperandrogenism may persist.[31]Azziz R, Carmina E, Chen Z, et al. Polycystic ovary syndrome. Nat Rev Dis Primers. 2016 Aug 11;2:16057.
http://www.ncbi.nlm.nih.gov/pubmed/27510637?tool=bestpractice.com
[193]Millán-de-Meer M, Luque-Ramírez M, Nattero-Chávez L, et al. PCOS during the menopausal transition and after menopause: a systematic review and meta-analysis. Hum Reprod Update. 2023 Nov 2;29(6):741-72.
http://www.ncbi.nlm.nih.gov/pubmed/37353908?tool=bestpractice.com