Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

Abstract

Polycystic ovary syndrome (PCOS) is a very common endocrine and metabolic disorder with the involvement of both genetic and environmental factors. Although much has been clarified on its pathogenesis, diagnosis, clinical manifestations, and therapy, there are still areas of uncertainty. To address fundamental concepts, novel aspects and hypotheses, and future perspectives, including the possible additional benefits of treatment with nutraceuticals, an expert consensus panel formed by endocrinologists and gynecologists was established. After an independent review of the literature, the panel convened electronically on February 3, 2020, and six resolutions were created, debated, and agreed upon discussion, and finally approved in their final form in a consensus livestream meeting held on April 15. The summary of the resolutions are: (1) PCOS is a well-established medical condition that negatively affects reproduction, general health, sexual health, and quality of life; (2) the symptoms and signs of PCOS appear early in life especially in female newborns from PCOS carriers; (3) women with PCOS have significantly increased risk of pregnancy-related complications including gestational diabetes mellitus; (4) a male PCOS equivalent exists, and it may impact on metabolic health and probably on reproduction; (5) the evidence supports that medical therapy for PCOS is effective, rational, and evidence-based; (6) the evidence supports a major research initiative to explore possible benefits of nutraceutical therapy for PCOS. The proposed resolutions may be regarded as points of agreement based on the current scientific evidence available.

Adipose Tissue and Endocrine-Disrupting Chemicals: Does Sex Matter?

“…On the one hand, metabolic dysfunction and predisposition to diabetes is observed in males with androgen deficiency and in females with hyperandrogenism as shown with the polycystic ovary syndrome (PCOS), a very common disorder in women of childbearing age with a prevalence of 6–15%. Insulin resistance is a fundamental pathogenic metabolic component in PCOS in addition to the high prevalence of abdominal obesity, type 2 diabetes, and metabolic syndrome [ 54 ]. On the other hand, direct effects of androgens on adipocyte proliferation and differentiation are inhibitory [ 33 ].…”

“…Specifically, female mice showed a transient early-life increased in body weight caused by BAT dysfunction and decreased energy expenditure leading to insulin resistance and the metabolic syndrome in adult mice fed a high-fat diet [ 181 ]. Another study showed that neonatal exposure of female mice to testosterone resulted in a masculinized pattern of fat accumulation with increased visceral adiposity and enlarged adipocytes and many of the features observed in women with PCOS [ 54 ]. In parallel, neonatal treatment of males with androgens showed reduced lean mass and food intake but enhanced subcutaneous adiposity and other characteristics of central hypogonadism with low testosterone levels [ 27 ].…”

Vitamin D, Bone Metabolism, and Fracture Risk in Polycystic Ovary Syndrome

“…In addition, a recent meta-analysis, including 10 randomized controlled trials, has shown a significant reduction of fasting glucose levels but no significant effect on fasting insulin concentration and HOMA-IR, in vitamin D-deficient PCOS women [ 74 ]. Overall, vitamin D supplementation appears to have beneficial effects on IR and dysglycemia and could as well modulate bone metabolism [ 66 , 67 , 75 , 76 , 77 ].…”

Вплив Хірургічної Стимуляції Овуляції Шляхом Фертилоскопічного Оваріального Дрилінгу На Гормональний Статус Пацієнток Із Кломіфен-Резистентною Формою Синдрому Полікістозних Яєчників Та Ожирінням

“…Синдром полікістозних яєчників (СПКЯ) -найбільш часте ендокринологічне та метаболічне порушення, про яке повідомляють жінки репродуктивного віку [6,10]. У глобальному масштабі частота цього синдрому варіює від 6 до 20 % [2,20] залежно від застосовуваних діагностичних критеріїв, із більш високою поширеністю серед жінок із надмірною масою або ожирінням і в певних етнічних групах [17,24].…”