Polycystic ovary syndrome: individualized approach to treatment. Literature review

Abstract

Polycystic ovary syndrome (PCOS) is one of the most common causes of hyperandrogenism, menstrual irregularity and cardiometabolic dysfunction in women. The complete clinical picture includes irregular menstrual cycle, hirsutism, obesity, insulin resistance and anovulatory infertility. This article highlights the main issues for the PCOS definition, emphasizing its phenotypic heterogeneity. The main diagnostic criteria are given, which in turn determine the different phenotypes of this syndrome. To date, in order to improve the diagnosis and treatment of this syndrome, four different phenotypes have been identified, which include certain combinations of diagnostic criteria: 1) hyperandrogenism (clinical or biochemical) and chronic anovulation; 2) hyperandrogenism and polycystic ovaries on ultrasound, but with ovulatory cycles; 3) chronic anovulation and polycystic ovaries without hyperandrogenemia; 4) hyperandrogenemia, chronic anovulation and polycystic ovaries. This article presents the main groups of drugs that should be used in treatment of this pathology, according to the latest international guidelines, systematic reviews and meta-analyzes. In particular, indicated application features of insulin sensitizers and other antidiabetic drugs, glucagon-like peptide-1 analogues, oral contraceptives and progestins, antiandrogens. Particular attention is paid to the treatment choice depending on the phenotype and individual needs of patient. Therapeutic approach to the metabolic, hyperandrogenic and reproductive phenotype is covered separately. Anovulation or infrequent ovulation is a major cause of reproductive dysfunction in women with PCOS. The article lists the main methods and drugs that should be used to induce ovulation. In particular, the features of ovulation induction in women with clomiphene-resistance are considered. The cornerstone of treatment of women with PCOS and obesity with abdominal phenotype is a lifestyle modification, including diet and exercises. The clinical recommendations given in the article are based on the principles of evidence-based medicine

Keywords

• polycystic ovary syndrome
• hyperandrogenism
• anovulation
• obesity
• treatment
• antiandrogens