Recent advances in the understanding and management of polycystic ovary syndrome

Ana L Rocha, Flávia R Oliveira, Rosana C Azevedo, Virginia A Silva, Thais M Peres, Ana L Candido, Karina B Gomes, Fernando M Reis, Ana L Rocha, Flávia R Oliveira, Rosana C Azevedo, Virginia A Silva, Thais M Peres, Ana L Candido, Karina B Gomes, Fernando M Reis

Abstract

Polycystic ovary syndrome (PCOS) is a multifaceted condition characterized by chronic anovulation and excess ovarian activity, in contrast to other causes of anovulation that involve ovarian dormancy or primary insufficiency. Recent studies indicated that PCOS is associated with low-grade chronic inflammation and that women with PCOS are at increased risk of non-alcoholic fatty liver disease. The inflammatory and metabolic derangements associated with PCOS are explained in part by the coexistence of insulin resistance and obesity but are further fueled by the androgen excess. New insights into the regulation of hormones and cytokines in muscle and fat tissue support the concept that PCOS is a systemic syndrome. The therapeutic plan should be tailored to the patient phenotype, complaints, and reproductive desire. Of note, the aromatase inhibitor letrozole seems to be more effective than the reference drug clomiphene citrate to treat infertility due to PCOS. Integral management by a multidisciplinary team may help the patients to adhere to lifestyle interventions and thereby reduce body adiposity and recover their metabolic and reproductive health.

Keywords: PCOS; infertility; insulin resistance; menstrual irregularity; polycystic ovary syndrome.

Conflict of interest statement

No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.

Figures

Figure 1.. Schematic representation of some pathophysiological…
Figure 1.. Schematic representation of some pathophysiological mechanisms of polycystic ovary syndrome.
The main clinical manifestations are shown in rectangular boxes. Androgens are responsible for dermatological symptoms, while sustained estrogen production by the ovaries and subcutaneous fat without progesterone opposition produces menstrual irregularity and increases the risk of endometrial hyperplasia. Adipokines and myokines may also be involved in the metabolic alterations associated with the syndrome. Insulin resistance and the compensatory hyperinsulinemia are central mechanisms that perpetuate anovulation and lead to metabolic complications. AMH, anti-Müllerian hormone; FSH, follicle-stimulating hormone; IGF-I, insulin-like growth factor I; LH, luteinizing hormone; NAFLD, non-alcoholic fatty liver disease; SHBG, sex hormone–binding globulin.
Figure 2.. Patient-centered care by a multidisciplinary…
Figure 2.. Patient-centered care by a multidisciplinary team may help reach the main goals of polycystic ovary syndrome management.
These goals are symptom relief, safe fertility planning, general well-being, and prevention of long-term complications.
Figure 3.. Objectives of assessing the quality…
Figure 3.. Objectives of assessing the quality of life in women with polycystic ovary syndrome.

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