Should all women with PCOS be treated for insulin resistance?

PRO--A large majority of women with PCOS have insulin resistance, compensatory hyperinsulinemia with consequent reproductive and metabolic abnormalities. Metformin has been shown to be effective therapy and could be used more widely in obese adolescents with hyperandrogenemia, a forerunner of PCOS. CON--The severity of insulin resistance is highly variable in women with PCOS and may not be clinically relevant in milder phenotypes. Treatment should be directed at specific metabolic or reproductive problems and insulin sensitizing drugs are not always the optimum therapy.