Modern aspects of management of patients with polycystic ovary syndrome

Abstract

The review article provides concepts of etiology, pathogenesis, and management of polycystic ovary syndrome (PCOS) in accordance with current international guideline and modern literature. The problem`s relevance is due not only to the prevalence of the syndrome among women of reproductive age – 8–13 %, 80 % – in the structure of anovulatory infertility. Тhe etiology of the syndrome remains controversial, and PCOS clinical manifestations are among the most common in the structure of reproductive health disorders, which consequently leads to impaired functioning of almost all organs and systems of the body. Therefore, the syndrome is considered as a multisystem problem; it implies comprehensive approach to the correction of this condition by gynecologists, fertility specialists, endocrinologists, cardiologists, dermatologists and family doctors. Rotterdam criteria remain relevant in the international guideline (2018) for PCOS diagnosis. For the sake of completeness, the classification of PCOS by phenotype remains relevant, which can help to assess the level of risk and the profile of possible concomitant disorders and to develop a rational, individualized plan for examination and treatment of the patient. The optimal diagnostic algorithm for PCOS at stage 1 presumes determining free testosterone index (total testosterone, sex hormone-binding globulin, free testosterone index). At stage 2, thyroid pathology should be excluded. This includes the following tests and examinations: thyroid-stimulating hormone, thyroidglobulin antibodies, Peroxidasa antibodies, ultrasound examination, hyperprolactinemia (prolactinoma), congenital suprarenal dysfunction (21-hydroxylase deficiency), Itsenko–Cushing’s syndrome, acromegaly, virilizing tumors. At stage 3, glycemic status is detected. The management should be multidisciplinary, aimed at the correction of lifestyle, psycho-emotional disorders, and diet. Pharmacological therapy depends on the kind of metabolic and hormonal disorders. Timely diagnosis, prevention, early start of PCOS therapy can contribute to the preservation of fertile potential, prevention of hyperplastic and neoplastic endometrial processes, late complications of this syndrome.

Keywords

• polycystic ovary syndrome
• pathogenesis
• phenotypes
• diagnosis
• treatment