**2.1. Management of underlying metabolic disorders, reduction of risk factors for type 2 diabetes and cardiovascular disease**

#### *2.1.1. Obesity*

Under the metabolic disorders, which are commonly encountered in patients with PCOS, it is worth mentioning: obesity, insulin resistance, metabolic syndrome, dyslipidemia, and type 2 diabetes mellitus.

Some researchers state that the obesity rate in the case of the women with PCOS is even up to 70%, but most agree that at least half of the women with PCOS suffer from obesity (body mass index (BMI) = 19–25 kg/m<sup>2</sup> ) [2] and in most cases, it is of a central distribution (waist circumference > 88 cm) [3]. Of the nonobese patients, one-third has increased intraabdominal fat [4]. There is no specific data on why the prevalence of obesity is much higher in women with PCOS, but most researchers attribute it to the hyperinsulinemia resulting from the insulin resistance, an important factor of adipogenesis, lipogenesis, and lipolysis inhibition [5].

#### *2.1.2. Increased insulin resistance*

Insulin resistance and reactive hyperinsulinemia are definitely implicated in the physiopathological mechanism of PCOS. With respect to insulin resistance, some authors consider it to be uncorrelated to the degree of the obesity [6], while others argue that the obesity, especially the central one, seems to increase the metabolic and clinical features of insulin resistance [7]. Although obese patients seem to be more affected by insulin resistance, this also occurs in the cases of nonobese patients with PCOS [8].

#### *2.1.3. Metabolic syndrome*

The metabolic syndrome is commonly associated with PCOS, with a prevalence ranging between 33 and 47% [9]. Both PCOS and the metabolic syndrome have features that generate an increased risk of cardiovascular diseases–if this risk is independent of PCOS or it is caused

by its association with the metabolic syndrome, it is still a topic of debate [10]. Studies demonstrate that in patients with PCOS, even if the criteria for the metabolic syndrome are not fully met, there is at least one component of the metabolic syndrome [11].

The research in the field demonstrates the presence of the risk factors for the metabolic syndrome in women with PCOS. Of these, the following appear to be important: the level of fasting insulin (which in these patients is doubled [12]) and obesity (an independent risk factor for the metabolic syndrome).
