Complications and challenges associated with polycystic ovary syndrome: Current perspectives

Polycystic ovary syndrome (PCOS) represents the most common endocrine dysfunction in fertile women and it is considered a heterogeneous and multifaceted disorder, with multiple reproductive and metabolic phenotypes which differently affect the early- and long-term syndrome’s risks. Women with PCOS present an adverse reproductive profile, including a high risk of pregnancy-induced hypertension, preeclampsia, and gestational diabetes mellitus. Patients with PCOS present not only a higher prevalence of classic cardiovascular risk factors, such as hypertension, dyslipidemia, and type-2 diabetes mellitus, but also of nonclassic cardiovascular risk factors, including mood disorders, such as depression and anxiety. Moreover, at the moment, clinical data on cardiovascular morbidity and mortality in women with PCOS are controversial. Finally, women with PCOS show an increased risk of endometrial cancer compared to non-PCOS healthy women, particularly during premenopausal period. Currently, we are unable to clarify if the increased PCOS early- and long-term risks are totally due to PCOS per se or mostly due to obesity, in particular visceral obesity, that characterized the majority of PCOS patients. In any case, the main endocrine and gynecological scientific societies agree to consider women with PCOS at increased risk of obstetric, cardiometabolic, oncology, and psychological complications throughout life, and it is recommended that these women be accurately assessed with periodic follow-up

Use of Metformin in the Treatment of Polycystic Ovary Syndrome

Metformin is quite an old drug, but it is optimal for the control of glycemia in Type 2 diabetes. It was reported, 15 years ago, that insulin resistance was abnormally high in most polycystic ovary syndrome (PCOS) patients. Starting from that moment, increasing numbers of studies were performed to demonstrate the efficacy of metformin in controlling and/or modulating several aspects of PCOS, which is the most common cause of menstrual irregularity, inesthetisms and infertility. Metformin induces higher glucose uptake, thus inducing a lower synthesis/secretion of insulin. Such an effect permits the possible restoration of the normal biological functions that are severely affected by the compensatory hyperinsulinemia reactive to the increased peripheral insulin resistance. These are the basis of the many positive effects of this drug, such as the restoration of menstrual cyclicity, ovulatory cycles and fertility, because abnormal insulin levels affect the hypothalamus–pituitary–ovarian function, as well as ..

Polycystic Ovary Syndrome

Brought into the limelight many decades ago, Polycystic Ovary Syndrome (PCOS) is still, to date, surrounded by controversy and mystery. Much attention has been attracted to various topics associated with PCOS research and there has been a healthy advance towards bettering the understanding of the many implications of this complex syndrome. A variety of topics have been dealt with by a panel of authors and compiled in this book. They span methods of diagnosis, reproductive anomalies, metabolic consequences, psychological mindset and ameliorative effects of various lifestyle and medical management options. These books are designed to update all associated professionals on the recent developments in this fast-growing field and to encourage further research into this thought-provoking subject

Inositol as putative integrative treatment for PCOS

Studies over the last decade have demonstrated that some polycystic ovary syndrome (PCOS) patients have abnormal insulin sensitivity (insulin resistance), independently from being overweight or obese. This induces the risk of developing type 2 diabetes in such PCOS patients. The use of insulin sensitizers (i.e. metformin), reduces such metabolic, and most hormonal, impairments. As metformin often induces side effects, new integrative strategies have been proposed to treat insulin resistance, such as the use of inositols. Such compounds are mainly represented in humans by two inositol stereoisomers: myo-inositol (MYO) and d-chiro-inositol (DCI). MYO is the precursor of inositol triphosphate, a second messenger that regulates thyroid-stimulating hormone (TSH) and FSH as well as insulin. DCI derives from the conversion of myo-inositol via an insulin-dependent pathway. Several preliminary studies have indicated possible benefits of inositol therapy in PCOS patients, but to date no meta-analysis has been performed. This review aims to give clinical insights for the clinical use of inositol in PCOS

How to control Polycystic Ovary Syndrome’s symptoms through pharmacological and non-pharmacological approaches

Polycystic Ovary Syndrome (PCOS) is a multisystemic disease highly prevalent in reproductive age women, with a prevalence of 20% (1), with many long-term health consequences. Even though these data are not very cheering, its pathophysiology remains poorly stablished. It seems that hyperandrogenism, hyperinsulinemia, ovarian disfunction, and obesity are involved in its development. The treatment of Polycystic Ovary Syndrome is not fully stablished yet and it depends on a variety of factors, including the patient’s phenotype, concerns, and main goals, approaching the most important symptoms for each patient and its will for pregnancy. Taking this into a count, the treatment includes lifestyle interventions, exercise, supplementation, and pharmacological treatment. Infertility is one of the consequences with the most impact on these women’s lives and their partners. Because of that, more often, these couples feel the need to seek help from Artificial Reproductive Techniques (ART). Even though they can achieve conception, the obstetric risks associated with PCOS remain high, such as early pregnancy loss and preeclampsia (73). There is a vast base of information on PCOS’s treatment which shows evidence for the usage of both pharmacological and non-pharmacological approaches. The reviewed studies lead us to believe that the adoption of an individualized and multidisciplinary treatment based on prevailing signs and symptoms is a pressing issue, including a holistic approach of each case, without discarding any kind of approach. Beside this, it is also necessary to bet on prevention and society’s literacy for the adoption of healthier lifestyles.A Síndrome de Ovários Poliquísticos (SOP) é uma doença multissistémica com elevada prevalência, até 20% de mulheres em idade fértil (1), com grandes consequências em saúde, a longo prazo. Apesar destes dados pouco animadores, a fisiopatologia desta doença permanece pouco esclarecida, sendo que o hiperandrogenismo, hiperinsulinemia, disfunção ovariana e obesidade parecem ser fatores importantes no seu desenvolvimento. O tratamento desta síndrome continua por estabelecer e depende de vários fatores, incluindo o fenótipo da doente, as suas preocupações e os seus objetivos, abordando os sintomas mais importantes para cada doente e a busca, ou não, de conceção. Inclui alterações do estilo de vida, prática de exercício físico, suplementação e medidas farmacológicas. A infertilidade é uma das consequências com maior impacto na vida destas mulheres e dos/das respetivos companheiros/as e que, muitas vezes, leva estes casais a recorrer a métodos de reprodução medicamente assistida (RMA). Mesmo após a conceção, os riscos obstétricos associados à SOP, permanecem elevados, tais como o risco de abortamento precoce e pré-eclampsia (73). A informação sobre o tratamento da SOP é vasta e mostra evidências para a utilização de duas abordagens, a farmacológica e não farmacológica. Os estudos realizados levam-nos a acreditar que é premente a adoção de um tratamento individualizado e multidisciplinar. Este deve ser baseado nos sinais e sintomas mais prevalentes, incluindo uma abordagem holística destas mulheres, sem descartar a utilização de nenhuma das terapêuticas. Ainda assim, é necessária uma aposta na prevenção e literacia da população, para a adoção de estilos de vida mais saudáveis

The Use of GLP-1 Receptor Agonists in the Treatment of Obesity in Women with PCOS

Introduction and aim of study: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting young women. It is diagnosed in individuals who meet 2 of the following 3 criteria: hyperandrogenism, ovarian dysfunction or polycystic ovarian morphology on ultrasound. A common component of this disease is obesity that leads to many serious health complications. This review paper aims to discuss the use of glucagon-like peptide-1 (GLP-1) receptor agonists as a therapeutic option to treat obesity in female patients with PCOS. Materials and Methods: The authors conducted a comprehensive review of the literature available in databases: PubMed and Medline focusing on the terms “PCOS”, “GLP-1”, “obesity”. Results: The first-line treatment of metabolic disorders in the course of PCOS is lifestyle modification. In patients who do not achieve sufficient results pharmacotherapy is recommended. Therapy with GLP-1 receptor agonists shows beneficial effects not only on weight loss, but also on metabolic and endocrine disorders. Studies have proven the superiority of these medications over metformin in the treatment of obesity associated with PCOS. However, the simultaneous use of GLP-1 receptor agonists and metformin may be beneficial for the patients. Conclusions: GLP-1 receptor agonists appear to be a promising therapeutic option in obese women with PCOS according to safety profile and effectiveness proven in studies

Endocrine and metabolic changes in women with polycystic ovaries and polycystic ovary syndrome

AbstractThe prevalence of the isolated ultrasonographic finding of polycystic ovaries (PCO) in the Finnish population and among women with a history of gestational diabetes (GDM) and changes in the present carbohydrate metabolism were investigated in the present study. One aim of this study was to investigate the prevalence of the recently discovered variant type LH (v-LH) in PCOS and to compare patient cohorts from Finland, the Netherlands, the United Kingdom and the United States of America. In addition, this study attempted to evaluate the nature of the ovarian streoidogenic response of women with PCOS to exogenously administered human chorionic gonadotrophin (hCG), human menotrophin (hMG) and follicle stimulating hormone (FSH). The effect of metformin on ovarian steroidogenesis was also studied.The prevalence of PCO was significantly higher in younger (≤ 35 years, 21.6%) than among older women (in ≥ 36 years, 7.8%). The overall prevalence of PCO in Finnish women was 14.2%. Women with previous GDM revealed a high prevalence of PCO (39.4%). The carrier frequency of the v-LHb allele in the entire study population was 18.5%. The frequency of the v-LH carrier was significantly lower in obese PCOS subjects in the Netherlands (2.0%) and Finland (4.5%). Women with previous GDM had impaired insulin sensitivity and β-cell function. They also had higher adrenal androgen secretion than the control women. Women with PCO and previous GDM had marked hyperinsulinemia which was not explained by obesity. Obese PCOS women achieved peak peripheral serum T concentrations at 48 hours after a hCG injection, preceded by peak levels of 17-OHP and E2 at 24 hours. In contrast, all steroids measured in the control women reached their maximum serum concentrations at 96 hours. HMG stimulated the production of ovarian androgens more efficiently than a urinary FSH after pituitary suppression with a gonadotrophin releasing hormone agonist (GnRHa).In conclusion, the prevalence of PCO is common in healthy Finnish women and even more common in women with a history of GDM. The ultrasonographic appearance of PCO may be a predictive factor with regards abnormal glucose tolerance during and after pregnancy and, these women should therefore be advised as to possible consequences. The high overall frequency of the v-LH allele in women in general and its low frequency in obese PCOS patients suggests that v-LH plays a role in reproductive functions and may counteract the pathogenesis of PCOS in obese individuals. The differences observed in steroid responses to hCG between normal and PCOS women might be explained by higher theca cell activity or mass in polycystic ovaries. Women with PCOS did not show a distinctly exaggerated steroidogenic response to hMG or FSH administration compared with control women. FSH administration also resulted in increased A and T production.Academic Dissertation to be presented with the assent of the Faculty of Medicine, University of Oulu, for public discussion in the Auditorium 4 of the University Hospital of Oulu, on August 24th, 2001, at 12 noon.Abstract The prevalence of the isolated ultrasonographic finding of polycystic ovaries (PCO) in the Finnish population and among women with a history of gestational diabetes (GDM) and changes in the present carbohydrate metabolism were investigated in the present study. One aim of this study was to investigate the prevalence of the recently discovered variant type LH (v-LH) in PCOS and to compare patient cohorts from Finland, the Netherlands, the United Kingdom and the United States of America. In addition, this study attempted to evaluate the nature of the ovarian streoidogenic response of women with PCOS to exogenously administered human chorionic gonadotrophin (hCG), human menotrophin (hMG) and follicle stimulating hormone (FSH). The effect of metformin on ovarian steroidogenesis was also studied. The prevalence of PCO was significantly higher in younger (≤ 35 years, 21.6%) than among older women (in ≥ 36 years, 7.8%). The overall prevalence of PCO in Finnish women was 14.2%. Women with previous GDM revealed a high prevalence of PCO (39.4%). The carrier frequency of the v-LHb allele in the entire study population was 18.5%. The frequency of the v-LH carrier was significantly lower in obese PCOS subjects in the Netherlands (2.0%) and Finland (4.5%). Women with previous GDM had impaired insulin sensitivity and β-cell function. They also had higher adrenal androgen secretion than the control women. Women with PCO and previous GDM had marked hyperinsulinemia which was not explained by obesity. Obese PCOS women achieved peak peripheral serum T concentrations at 48 hours after a hCG injection, preceded by peak levels of 17-OHP and E2 at 24 hours. In contrast, all steroids measured in the control women reached their maximum serum concentrations at 96 hours. HMG stimulated the production of ovarian androgens more efficiently than a urinary FSH after pituitary suppression with a gonadotrophin releasing hormone agonist (GnRHa). In conclusion, the prevalence of PCO is common in healthy Finnish women and even more common in women with a history of GDM. The ultrasonographic appearance of PCO may be a predictive factor with regards abnormal glucose tolerance during and after pregnancy and, these women should therefore be advised as to possible consequences. The high overall frequency of the v-LH allele in women in general and its low frequency in obese PCOS patients suggests that v-LH plays a role in reproductive functions and may counteract the pathogenesis of PCOS in obese individuals. The differences observed in steroid responses to hCG between normal and PCOS women might be explained by higher theca cell activity or mass in polycystic ovaries. Women with PCOS did not show a distinctly exaggerated steroidogenic response to hMG or FSH administration compared with control women. FSH administration also resulted in increased A and T production

Implications of Insulin Resistance / Hyperinsulinemia on Reproductive Function in Infertile Women with Polycystic Ovary Syndrome

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