Advances in Clinical and Experimental Medicine

Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2017, vol. 26, nr 2, March-April, p. 359–367

doi: 10.17219/acem/59380

Publication type: review article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

The pathogenesis and treatment of polycystic ovary syndrome: What’s new?

Sylwia Bednarska1,A,B,C,D, Agnieszka Siejka1,B,C,D,E,F

1 Department of Clinical Endocrinology, Medical University of Lodz, Łódź, Poland

Abstract

Polycystic ovary syndrome (PCOS) is currently the leading cause of menstrual complications in women. It is characterized by clinical and/or biochemical hyperandrogenism, ovulation abnormalities and the presence of enlarged and/or polycystic ovaries in ultrasound images (12 or more small bubbles located circumferentially and/or ovarian volume > 10 mL). It is often comorbid with hyperinsulinemia, dyslipidemia, overweight or obesity, and is a risk factor for the development of diabetes and cardiovascular diseases (CVDs). The treatment of patients with PCOS depends on the prevailing symptoms. The aim of this paper is to present the etiopathogenesis, clinical and biochemical implications, and non-pharmacological and pharmacological treatment options – those approved by worldwide scientific organizations as well as new therapies whose initial results are encouraging enough to prompt researchers to explore them further.

Key words

treatment, statins, metformin, PCOS

References (44)

  1. Wołczyński S, Zgliczyński W. Abnormalities of the menstrual cycle. In: Large Interna – Endocrinology. 2nd edition. Medical Tribune Poland, Warsaw 2012, 561–567.
  2. The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41–47. doi: 10.1093/humrep/deh098.
  3. Milewicz A. Reimbursement of metformin for polycystic ovary syndrome. Endokrynol Pol. 2013;64(5):409–414. doi: 10.5603/EP.2013.0025.
  4. Morotti E, Battaglia B, Fabbri R, Paradisi R, Venturoli S, Battaglia C. Cigarette smoking and cardiovascular risk in young women with polycystic ovary syndrome. Int J Fertil Steril. 2014;7(4):301–312. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901187 [Published online 2013 Dec 22].
  5. Davies MJ, Marino JL, Willson KJ, March WA, Moore VM. Intergenerational associations of chronic disease and polycistic ovary syndrome. PLoS One. 2011;6(10):e25947. doi: 10.1371/journal.pone. 0025947.
  6. Tan S, Scherag A, Janssen OE et al. Large effects on body mass index and insulin resistance women with PCOS (FTO) variants in patients with polycystic ovary syndrome (PCOS). BMC Med Genet. 2010;11:12. doi: 10.1186/1471-2350-11-12.
  7. Fica S, Albu A, Constantin M, Dobri GA, Davila C. Insulin resistance and fertility in polycystic ovary syndrome. J Med Life. 2008;1(4):415–422. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018970/ Published online 2008 Nov 25.
  8. Traub ML. Assessing and treating insulin resistance in women with polycystic ovarian syndrome. World J Diabetes. 2011;2(3):33–40. doi: 10.4239/wjd.v2.i3.33.
  9. Sathyapalan T, Atkin ST. Mediators of inflammation in polycystic ovary syndrome in relation to adiposity. Mediat Inflamm. 2010;2010: 758656. doi: 10.1155/2010/758656.
  10. McClung J, Karl P. Iron deficiency and obesity: The contribution of inflammation and diminished iron absorption. Nutr Rev. 2009;67: 100–104. doi: 10.1111/j.1753-4887.2008.00145.x.
  11. Bentley-Lewis R, Selly E, Dunaif A. Ovarian hypertension: Polycystic ovary syndrome. Endocrinol Metab Clin North Am. 2011;40:433–449. doi: 10.1016/j.ecl.2011.01.009.
  12. Krępuła K, Bidzińska-Speichert B, Lenarcik A, Tworowska-Bardziń­ska U. Psychiatric disorders related to polycystic ovary syndrome. Pol J Endocrinol. 2012;63(6):488–491.
  13. Dumesic DA, Lobo RA. Cancer risk and PCOS. Steroids. 2013;78(8): 782–785. doi: 10.1016/j.steroids.2013.04.004.
  14. Stovall DW, Bailey AP, Pastore LM. Assessment of insulin resistance and impaired glucose tolerance in lean women with polycystic ovary syndrome. J Womens Health. 2011;20(1):37–43. doi: 10.1089/jwh.2010.2053.
  15. Sidhwani S, Scoccia B, Sunghay A, Stephens-Archer CN, Mazzone T, Sam S. PCOS is associated with atherogenic changes in lipoprotein parti-cle number and size independent of body weight. Clin Endocrinol. 2011;75:76–82. doi: 10.1111/j.1365-2265.2011.04015.x.
  16. Bu Z, Kuok K, Meng J, Wang R, Xu B, Zhang H. The relationship between polycystic ovary syndrome, glucose tolerance status and serum prep-tin level. Reprod Biol Endocrine. 2012;10:10. doi: 10.1186/ 1477-7827-10-10.
  17. Domecq JP, Prutsky G, Mullan RJ. Lifestyle modification programs in polycystic ovary syndrome: Systematic review and meta-analysis. J Clin Endocrinol Metab. 2013;98(12):4655–4663. doi: 10.1210/jc. 2013-2385.
  18. Kahal H, Atkin SL, Sathyapalan T. Pharmacological treatment of obesity in patients with polycystic ovary syndrome. J Obes. 2011: 402052. doi: 10.1155/2011/402052.
  19. Beck E, Scheen AJ. Metformin, an antidiabetic molecule with anti-cancer properties. Rev Med Liege. 2013;68(9):444–449.
  20. Chung HH, Moon JS, Yoon JS, Lee HW, Won KC. The relationship between metformin and cancer in patients with type 2 diabetes. Diabetes Metab J. 2013;37(2):125–131. doi: 10.4093/dmj.2013. 37.2.125.
  21. Metformin in dermatology: An overview. J Eur Acad Dermatol Venereol. 2013;Nov, 27:1329–1335. doi: 10.1111/jdv.12116.
  22. Tang T, Glanville J, Hayden CJ, White D, Barth JH, Balen AH. Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome: A randomized, placebo-controlled, double-blind multicentre study. Hum Reprod. 2006;21:80–89. doi: 10.1093/humrep/dei311.
  23. Oppelt PG, Mueller A, Jentsch K, et al. The effect of metformin treatment for 2 years without caloric restriction on endocrine and metabolic parameters in women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes. 2010;118:633–637. doi: 10.1055/s-0029-1237705.
  24. Malik SM, Traub M. Defining the role of bariatric surgery in polycystic ovarian syndrome patients. World J Diabetes. 2012;3(4):71–79. doi: 10.4239/wjd.v3.i4.71.
  25. Wolf JE, Shander D, Huber F, et al. Randomized, double-blind clinical evaluation of the efficacy and safety of topical eflornithine HCl 13.9% cream in the treatment of women with facial hair. Int J Dermatol. 2007;46:94–99. doi: 10.1111/j.1365-4632.2006.03079.x.
  26. Cakir GA, Erdogan FG, Gurler A. Isotretinoin treatment in nodulocystic acne with and without polycystic ovary syndrome: Efficacy and de-terminants of relapse. Int J Dermatol. 2013;Mar;52(3):371–376. doi: 10.1111/j.1365-4632.2012.05691.x.
  27. Çetinözman F, Yazgan AD, Elçin G, Yildiz BO. Insulin sensitivity, androgens and isotretinoin therapy in women with severe acne. J Dermatolog Treat. 2014;25(2):119–122. doi: 10.3109/09546634.2012.751482.
  28. Vexiau P, Chaspoux C, Boudou P, et al. Effects of minoxidil 2% vs. cyproterone acetate treatment on female androgenetic alopecia: A controlled, 12-month randomized trial. Br J Dermatol. 2002, 146(6):992–999. doi: 10.1046/j.1365-2133.2002.04798.x.
  29. Vinaixa M, Rodriguez MA, Samino S et al. Metabolomics reveals reduction of metabolic oxidation in women with polycystic ovary syndrome after pioglitazone-flutamide-metformin polytherapy. PLoS One. 2011;6(12):e29052. doi: 10.1371/journal.pone.0029052.
  30. Du Q, Yang S, Wang YJ, Wu B, Zhao YY, Fan B. Effects of thiazolidinediones on polycystic ovary syndrome: A meta-analysis of randomized placebo-controlled trials. Adv Ther. 2012;29(9):763–774. doi: 10.1007/s12325-012-0044-6.
  31. Jensterle Sever M, Kocjan T, Pfeifer M, Kravos NA, Janez A. Short-term combined treatment with liraglutide and metformin leads to signifi-cant weight loss in obese women with polycystic ovary syndrome and previous poor response to metformin. Eur J Endocrinol. 2014;170(3):451–459. doi: 10.1530/EJE-13-0797.
  32. Thomson RL, Spedding S, Brinkworth GD, Noakes M, Buckley JD. Seasonal effects on vitamin D status influence outcomes of lifestyle inter-vention in overweight and obese women with polycystic ovary syndrome. Fertil Steril. 2013;99(6):1779–1785. doi: 10.1016/j.fertnstert.2012.12.042.
  33. Celik O, Acbay O. Effects of metformin plus rosuvastatin on hyperandrogenism in polycystic ovary syndrome patients with hyperlipidemia and impaired glucose tolerance. J Endocrinol Invest. 2012;35(10):905–910. doi: 10.3275/8371.
  34. Sathyapalan T, Shepherd J, Coady AM, Kilpatrick ES, Atkin SL. Atorvastatin reduces malondialdehyde concentrations in patients with polycys-tic ovary syndrome. J Clin Endocrinol Metab. 2012;97(11): 3951–3955. doi: 10.1210/jc.2012-2279.
  35. Kimura Y, Hyogo H, Yamagishi S, et al. Atorvastatin decreases serum levels of advanced glycation endproducts (AGEs) in nonalcoholic stea-tohepatitis (NASH) patients with dyslipidemia: Clinical usefulness of AGEs as a biomarker for the attenuation of NASH. J Gastroenterol. 2010;45(7):750–757. doi: 10.1007/s00535-010-0203-y.
  36. Macut D, Bjekić-Macut J, Savić-Radojević A. Dyslipidemia and oxidative stress in PCOS. Front Horm Res. 2013;40:51–63. doi: 10.1159/ 000341683.
  37. Salehpour S, Tohidi M, Akhound MR, Amirzargar N. N-acetylcysteine: A novel remedy for polycystic ovarian syndrome. Int J Fertil Steril. 2009,3:66–73. https://www.researchgate.net/publication/ 228674382_N_Acetyl_Cysteine_A_novel_Remedy_for_Poly_Cystic_ Ovarian_Syndrome. Accessed 23 Aug 2009.
  38. Lansdown A, Rees DA. The sympathetic nervous system in polycystic ovary syndrome: A novel therapeutic target? Clin Endocrinol (Oxf). 2012;77(6):791–801. doi: 10.1111/cen.12003.
  39. Schlaich MP, Straznicky N, Grima M, et al. Renal denervation: A potential new treatment modality for polycystic ovary syndrome? J Hypertens. 2011;29(5):991–996. doi: 10.1097/HJH.0b013e328344db3a.
  40. Katoh M. FGFR2 abnormalities underlie a spectrum of bone, skin, and cancer pathologies. J Invest Dermatol. 2009;129:1861–1867. doi: 10.1038/jid.2009.97.
  41. Kharitonenkov A, Adams AC. Inventing new medicines: The FGF21 story. Mol Metab. 2014;3:221–229. doi: 10.1016/j.molmet.2013.12.003.
  42. Unfer V, Carlomagno G, Dante G, et al. Effects of myo-inositol in women with PCOS: A systematic review of randomized controlled trials. Gynecol Endocrinol. 2012;28(7):509–515. doi: 10.3109/ 09513590.2011.650660.
  43. Erin Barthelmess Rajesh KN. Polycystic ovary syndrome: Current status and future perspective. Front Biosci. 2014;6:104–119. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341818/. Published online 2014 Jan 1.
  44. Sunita J. Ramanand, Balasaheb B. Ghongane, Jaiprakash B. Rama­nand, et al. Clinical characteristics of polycystic ovary syndrome in Indian women. Indian J Endocrinol Metab. 2013;17(1):138–145. doi: 10.4103/2230-8210.107858.