**10.3 Metabolic syndrome and female reproductive health**

Metabolic disorders, including diabetes, obesity, and hyperlipidaemia plays a significant role in the development of female-specific reproductive health issues, which have a significant impact on public health. MetSy also increases the risk of reproductive cancers such as, breast, endometrial, bladder and cervical cancers [73]. Obesity particularly impacts women of reproductive age, as it is associated with an increased risk of infertility and adverse obstetric outcome such as miscarriage, stillbirth, birth defects and cesarean section [70, 75, 76]. MetSy can affect women's reproductive health and fertility directly or indirectly by interfering with the hypothalamic – pituitary – gonadal (HPG) axis function. MetSy creates conditions of negative energy balance and metabolic stress which cause hypogonadism by suppressing the expression of the hypothalamic KiSS/kisspeptin [77, 78].

In addition to the effect of peripheral aromatization which create the hypogonadotropic hypogonadism state in obese women, a lack of residual insulin secretion in diabetes is also associated with the status quo [79]. The hypothalamic origin of the decreased levels of gonadotropin in amenorrhoeic and diabetic patients are related to a toxic effect of hyperglycaemia on the neurons of the hypothalamus leading to reduced LH response to GnRH stimuli [80].
