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Chapter 13 - Polycystic Ovary Syndrome

from Section 3 - Reproductive Endocrinology and Infertility

Published online by Cambridge University Press:  24 November 2021

By
Ioannis E. Messinis ,
Christina I. Messini  and
Alexandros Daponte
Edited by
Tahir Mahmood ,
Charles Savona-Ventura ,
Ioannis Messinis  and
Sambit Mukhopadhyay
Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona-Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
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Summary

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women during reproductive life. The aetiology of the syndrome is unknown; however, many endocrine changes occur, such as insulin resistance and hyperinsulinaemia, hyperandrogenaemia, elevated LH and increased anti-Müllerian hormone, which contribute to the pathogenesis of the syndrome. There are three main characteristics which play key roles in the definition of the syndrome – menstrual irregularities, hyperandrogenism and polycystic morphology of the ovaries – but there is no consensus as to the gravity of each of these features. The management of the syndrome depends on the prevailing symptom and whether the woman is interested in becoming pregnant or not. Combined oral contraceptive pills, diet, lifestyle changes, ovulation-inducing drugs and in-vitro fertilization are the main means of treating the syndrome. Treatment should also take into account possible long-term consequences of this condition, such as metabolic syndrome and cancer development.

Keywords

PCOShyperandrogenisminsulin resistancemetforminovulation inductionlifestyle modificationIVF
Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Gynaecology
 , pp. 108 - 116
Publisher: Cambridge University Press
Print publication year: 2021

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References

Norman, RJ, Dewailly, D, Legro, RS, Hickey, TE. Polycystic ovary syndrome. Lancet 2007;370:685–697.Google Scholar
Escobar-Morreale, HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol 2018;14:270–284.CrossRefGoogle ScholarPubMed
Zawadzki, J, Dunaif, A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Polycystic Ovary Syndrome. Oxford: Blackwell Scientific; 1992, pp. 377–384.Google Scholar
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;19:41–47.Google Scholar
Azziz, R, Carmina, E, Dewailly, D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009;91:456–488.Google Scholar
Zhang, HY, Zhu, FF, Xiong, J, Shi, XB, Fu, SX. Characteristics of different phenotypes of polycystic ovary syndrome based on the Rotterdam criteria in a large-scale Chinese population. BJOG 2009;116:1633–1639.CrossRefGoogle Scholar
Teede, HJ, Misso, ML, Costello, MF, et al.Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018;33:1602–1618.CrossRefGoogle ScholarPubMed
Homburg, R, Ray, A, Bhide, P, et al. The relationship of serum anti-Mullerian hormone with polycystic ovarian morphology and polycystic ovary syndrome: a prospective cohort study. Hum Reprod 2013;28:1077–1083.CrossRefGoogle ScholarPubMed
Skiba, MA, Islam, RM, Bell, RJ, Davis, SR. Understanding variation in prevalence estimates of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2018;24:694–709.CrossRefGoogle ScholarPubMed
De Leo, V, Musacchio, MC, Cappelli, V, et al. Genetic, hormonal and metabolic aspects of PCOS: an update. Reprod Biol Endocrinol 2016;14:38.Google Scholar
De Leo, V, la Marca, A, Petraglia, F. Insulin-lowering agents in the management of polycystic ovary syndrome. Endocr Rev 2003;24:633–667.CrossRefGoogle ScholarPubMed
Markopoulos, MC, Rizos, D, Valsamakis, G, et al. Hyperandrogenism in women with polycystic ovary syndrome persists after menopause. J Clin Endocrinol Metab 2011;96:623–631.CrossRefGoogle ScholarPubMed
Rosenfield, RL, Ehrmann, DA. The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocr Rev 2016;37:467–520.Google Scholar
Taylor, AE, McCourt, B, Martin, KA, et al. Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab 1997;82:2248–2256.Google ScholarPubMed
Dafopoulos, K, Venetis, C, Pournaras, S, Kallitsaris, A, Messinis, IE. Ovarian control of pituitary sensitivity of luteinizing hormone secretion to gonadotropin-releasing hormone in women with the polycystic ovary syndrome. Fertil Steril 2009;92:1378–1380.Google Scholar
Franks, S, Mason, H, Willis, D. Follicular dynamics in the polycystic ovary syndrome. Mol Cell Endocrinol 2000;163:49–52.Google Scholar
Garg, D, Tal, R. The role of AMH in the pathophysiology of polycystic ovarian syndrome. Reprod Biomed Online 2016;33:15–28.Google Scholar
Panda, PK, Rane, R, Ravichandran, R, Singh, S, Panchal, H. Genetics of PCOS: A systematic bioinformatics approach to unveil the proteins responsible for PCOS. Genom Data 2016;8:52–60.CrossRefGoogle ScholarPubMed
Chen, Y, Fang, SY. Potential genetic polymorphisms predicting polycystic ovary syndrome. Endocr Connect 2018;7:R187–R195.Google Scholar
Setji, TL, Brown, AJ. Polycystic ovary syndrome: update on diagnosis and treatment. Am J Med 2014;127: 912–919.CrossRefGoogle ScholarPubMed
Bellver, J, Rodríguez-Tabernero, L, Robles, A, et al. Polycystic ovary syndrome throughout a woman’s life J Assist Reprod Genet 2018;35:25–39.Google Scholar
Spritzer, PM, Lecke, SB, Satler, F, Morsch, DM. Adipose tissue dysfunction, adipokines, and low-grade chronic inflammation in polycystic ovary syndrome. Reproduction 2015;149:R219–R227.Google Scholar
Messinis, IE, Messini, CI, Anifandis, G, Dafopoulos, K. Polycystic ovaries and obesity. Best Pract Res Clin Obstet Gynaecol 2015;29:479–488.Google Scholar
Norman, RJ, Davies, MJ, Lord, J, Moran, LJ. The role of lifestyle modification in polycystic ovary syndrome. Trends Endocrinol Metab 2002;13:251–257.Google Scholar
Messinis, IE. Ovulation induction: a mini review. Hum Reprod 2005;20:2688–2697.Google Scholar
Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod 2008;23:462–477.Google Scholar
Balen, AH, Morley, LC, Misso, M, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update 2016;22:687–708.Google Scholar
Messinis, IE. Clomiphene citrate. In: Ovulation Induction. Amsterdam: Elsevier; 2002, pp. 87–97.Google Scholar
Casper, RF, Mitwally, MF. Use of the aromatase inhibitor letrozole for ovulation induction in women with polycystic ovarian syndrome. Clin Obstet Gynecol 2011;54:685–695.CrossRefGoogle ScholarPubMed
Legro, RS, Brzyski, RG, Diamond, MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med 2014;371:119–129.Google Scholar
Franik, S, Eltrop, SM, Kremer, JA, Kiesel, L, Farquhar, C. Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev 2018;5:CD010287.Google Scholar
White, DM, Hardy, K, Lovelock, S, Franks, S. Low-dose gonadotropin induction of ovulation in anovulatory women: still needed in the age of IVF. Reproduction 2018;156:F1–F10.CrossRefGoogle ScholarPubMed
Messinis, IE, Milingos, SD. Current and future status of ovulation induction in polycystic ovary syndrome. Hum Reprod Update 1997;3:235–253.CrossRefGoogle ScholarPubMed
Mahran, A, Abdelmeged, A, El-Adawy, AR, et al. The predictive value of circulating anti-Müllerian hormone in women with polycystic ovarian syndrome receiving clomiphene citrate: a prospective observational study. J Clin Endocrinol Metab 2013;98:4170–4175.CrossRefGoogle ScholarPubMed
Amer, SA, Mahran, A, Abdelmaged, A, et al. The influence of circulating anti-Müllerian hormone on ovarian responsiveness to ovulation induction with gonadotrophins in women with polycystic ovarian syndrome: a pilot study. Reprod Biol Endocrinol 2013;11:115.Google Scholar
Farquhar, C, Brown, J, Marjoribanks, J. Laparoscopic drilling by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev 2012;6:CD001122.Google Scholar
Bordewijk, EM, Nahuis, M, Costello, MF, et al. Metformin during ovulation induction with gonadotrophins followed by timed intercourse or intrauterine insemination for subfertility associated with polycystic ovary syndrome. Cochrane Database Syst Rev 2017;1:CD009090.Google Scholar
Youssef, MA, Van der Veen, F, Al-Inany, HG, et al. Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology. Cochrane Database Syst Rev 2014;10:CD008046.Google Scholar

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