An update of polycystic ovary syndrome: causes and therapeutics options

Rababa’h, Abeer; Matani, Bayan R.; Yehya, Alaa

doi:10.1016/j.heliyon.2022.e11010

Cited by 19 publications

(19 citation statements)

References 112 publications

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“…This meta-analysis showed a higher clinical pregnancy rate in all treatment groups compared to placebo. 80-85% of women with PCOS ovulate after treatment with clomiphene citrate, and 15-20% are resistant to it and do not respond to doses up to 150 mg/day for 5 days for at least three courses of treatment [1].…”

Section: Treatment Of Irregular Menstrual Cycle and Hyperandrogenismmentioning

confidence: 99%

“…The disadvantage is the increased risk of ovarian hyperstimulation syndrome and multiple pregnancy [1].…”

Section: Treatment Of Irregular Menstrual Cycle and Hyperandrogenismmentioning

confidence: 99%

“…Preantral and primary antral follicles that accumulate in women with PCOS increase anti-Müllerian hormone (AMH) secretion, altering the follicular environment and GnRH secretion, which exacerbates ovarian dysfunction [6]. AMH may serve as a molecular biomarker for PCOS and comparative ovarian size [1].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, treatment strategies are symptomatic and depend on desired goals and clinical preferences. PCOS can lead to serious complications such as metabolic syndrome, type 2 diabetes, dyslipidemia, endometrial cancer, and cardiovascular disease [1].…”

Section: Introductionmentioning

confidence: 99%

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Modern Aspects of Treatment of Women With Polycystic Ovary Syndrome

Semenyna

2023

Grundlagen Der Modernen Wissenschaftlichen Forschung

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Polycystic ovary syndrome (PCOS) is one of the most common neuroendocrine syndromes of reproductive age, affecting up to 20% of women in this age group. This condition is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovary morphology. In the pathophysiology of PCOS, there is a violation of the circadian rhythm of GnRH secretion, which increases the release of LH and decreases FSH. The latter is necessary for the synthesis of aromatases, which convert androgens into estrogens [7]. Another pathophysiological link in the development of PCOS is insulin resistance. Androgen hypersecretion increases the level of insulin resistance, and the hyperinsulinemia that develops due to insulin resistance further increases androgen secretion and induces the production of sex hormone-binding globulin (SHBG) in the liver, thereby increasing the concentration of free testosterone in the blood and even more aggravates disorders associated with hyperandrogenism. In 2003, a consensus of experts at a joint ESHRE/ASRM symposium in Rotterdam adopted diagnostic criteria (remaining relevant to this day), which include a triad of signs: oligoovulation or anovulation; hyperandrogenism (clinical and/or biochemical manifestations); polycystic ovaries detected during ultrasound; diagnosed on the basis of at least two of the following signs [7]. Patients may have different manifestations of this triad depending on the disease phenotype, patient age, and lifestyle. Therefore, treatment strategies are symptomatic and depend on desired goals and clinical preferences.

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Section: Treatment Of Irregular Menstrual Cycle and Hyperandrogenismmentioning

confidence: 99%

“…The disadvantage is the increased risk of ovarian hyperstimulation syndrome and multiple pregnancy [1].…”

Section: Treatment Of Irregular Menstrual Cycle and Hyperandrogenismmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Modern Aspects of Treatment of Women With Polycystic Ovary Syndrome

Semenyna

2023

Grundlagen Der Modernen Wissenschaftlichen Forschung

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“…The low dose protocol has essentially replaced the original conventional protocols (12) . In a recent randomized trial, low dose, exogenous FSH has been suggested as the first line of treatment in PCOS (13) .…”

Section: Introductionmentioning

confidence: 99%

Metformin plus Clomiphene Citrate versus Gonadotropins in Clomiphene Citrate- Resistant Polycystic Ovary Syndrome

Midan

Bassioune

Hassan³

2022

SJMS

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Introduction: Clomiphene citrate (CC) is the ﬁrst-line pharmacological therapy for ovulation induction in polycystic ovary syndrome (PCOS). However, 15%-40% of patients show CC-resistance. Different drugs and drug combinations were in trial to overcome resistance. Aim of the study: comparison between the metformin plus CC and low dose exogenous follicle stimulating hormone (FSH) in CC-resistant PCOS. Subjects and methods: A prospective comparative trial was carried out for a period of 36 months (between June 2019 to June 2022) with ovulation induction period of 3 months. It included 40 patients with CC- resistance. They were divided into 2 groups. The first received metformin plus CC and the second received low dose exogenous FSH for 3 months. The cycles were monitored by transvaginal sonography (TVS), starting on the 11th day of the cycle. The primary outcome was the successful ovulation, and the secondary outcome was the detection of pregnancy sac (clinical pregnancy). Results: Metformin plus CC succeeded to produce a higher rate of ovulation. However, gonadotrophins are more effective as it produced a significantly higher rate in the first cycle (45.0% vs. 15%). However, there were no significant differences at the second and third cycles. The overall ovulation rate was 60% and 80.0% in metformin-CC group compared to gonadotrophin group. The clinical pregnancy rate was 25% and 15% in groups I and II, respectively (p value >0.05). Complications were confined to gonadotrophin group (multiple pregnancy and ovarian hyperstimulation syndrome (each in one patient). Conclusions: Gonadotrophins are more effective than metformin plus CC in the management of CC-resistant PCOS. However, it was associated with lower clinical pregnancy rate and higher complications rate. But the difference was statistically non-significant.

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