Various studies have reported different levels of obesity, with the highest percentages being in the Western world, including the United States, the United Kingdom, and Australia. Obesity, but also associated menstrual disturbances, hirsutism, acne, and male pattern of alopecia, in women with androgen excess all contribute to the poor quality of life of these patients. Furthermore, obesity is also associated with a number of health problems, including infertility, miscarriage, adverse pregnancy outcomes, type 2 diabetes mellitus, hyperlipidemia, heart disease, osteoarthritis, and other serious health outcomes. PCOS is a heterogeneous clinical syndrome characterized by hyperandrogenism with chronic anovulation in women without specific adrenal or pituitary gland

Fig. 1. Schematic representation of how insulin resistance may contribute to the androgen excess of polycystic ovary syndrome (PCOS). SHBG, sex hormone-binding globulin; LH, luteinizing hormone; FSH, follicle-stimulating hormone.

disease. The age of onset is frequently perimenarchal, and, in some cases, premature adrenarche may be a precursor to the development of the syndrome.

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