Cardiometabolic Risks in PCOS: Time to Think Beyond Reproduction

Polycystic Ovarian Syndrome (PCOS) is too often boxed into the realm of reproductive health. Yet, its real burden may lie in the silent cardiometabolic risks it carries. Women with PCOS are more likely to face obesity, insulin resistance, dyslipidemia, and even early vascular changes—harbingers of cardiovascular disease. The debate over whether PCOS directly raises cardiovascular event risk should not distract us: the clustering of risk factors demands early, aggressive intervention.

Lifestyle modification remains the first prescription, but let’s be honest—diet and exercise alone are rarely sustainable for many women struggling with obesity and insulin resistance. Metformin has long been the workhorse, but newer agents like GLP-1 receptor agonists offer transformative potential by tackling both weight and metabolic dysfunction. Combined strategies—COCPs for androgen excess, metformin or GLP-1RAs for insulin resistance—reflect the modern, multi-targeted approach we should be championing.

Emerging therapies like inositols may help, but the evidence is still thin. For women with severe obesity, bariatric surgery is not just a weight-loss tool—it can reset metabolic and reproductive health within a year.

The message is clear: PCOS is not just about periods and pregnancy. If we fail to address its cardiometabolic footprint, we miss the bigger picture. Treatment must evolve from symptom control to long-term risk reduction. The time for a holistic, cardiometabolic-centered strategy in PCOS is now. 

Source: Medicina (Kaunas). 2024 Oct 10;60(10):1656. doi: 10.3390/medicina60101656.