Background: Lipids are essential components of cells that participate in
metabolic and endocrine regulation and reproductive functions. The main organs where
lipid regulation takes place are the liver and adipose tissue. Besides, when each tissue-
specific action cannot be exerted, it could lead to several endocrine-metabolic disorders
closely related to PCOS, such as non-alcoholic fatty liver disease (NAFLD) and obesity.
Objective: This work aims to discuss the impact of lipid alterations on metabolic and reproductive
health. Therefore, this review focus on the importance of carrying out an integrated
study of the molecular pathways affected in PCOS for developing target therapies.
Results: Lipids play a major role in PCOS pathogenesis. In this regard, failures in lipid
regulation, synthesis, and/or homeostasis contribute to metabolic and reproductive abnormalities,
such as those seen in PCOS. Several lipid pathways and regulators are altered in
this pathology, leading to dysfunctions that worsen reproductive functions. Therefore,
there are several treatments to manage dyslipidemias. Non-pharmacological therapies are
considered a first-line treatment being the pharmacological treatments a second-line option.
Conclusion: The best treatment to improve the lipid profile is lifestyle intervention, a
combination of hypocaloric diet and exercise. Regarding pharmacological therapies, a
combination of fibrate and statins would be the most recommended drugs. Still, in PCOS
women, treatment with metformin or TZDs not only modulates the lipid metabolism, but
also improves ovulation. In addition, metformin with lifestyle interventions has positive
effects on the metabolic and reproductive features of PCOS patients.