chapter  9
Insulin-lowering agents
Pages 8

A large majority of women who have PCOS and hyperinsulinemia are obese.1,2 Obesity in women with PCOS exacerbates insulin resistance and its associated clinical sequelae, as central obesity and body mass index (BMI) are major determinants of insulin resistance, hyperinsulinemia and hyperandrogenemia. Insulin stimulates luteinizing

hormone (LH) and ovarian androgen secretion and decreases sex hormone binding globulin (SHBG) concentrations, thereby increasing the circulation of more free, biologically active testosterone.3 Now that obesity is reaching epidemic proportions in some countries, we tend to see more expression of the stigmata of PCOS: hirsutism, acne, anovulation and infertility.