Targets to treat metabolic syndrome in polycystic ovary syndrome

Abstract

Introduction Metabolic syndrome is comprised of a combination of the following states: increased insulin resistance, dyslipidemia, cardiovascular disease, and increased abdominal obesity. Women with polycystic ovary syndrome (PCOS) have an increased risk of developing metabolic syndrome over the course of their lives. Metabolic syndrome increases risk of major cardiovascular events, morbidity, quality of life, and overall health care costs. Though metabolic syndrome in women with PCOS is an area of great concern, there is no effective individual medical therapeutic to adequately treat this issue. Areas Covered This article will review key aspects of metabolic syndrome in PCOS. We will discuss classic and novel therapeutics to address metabolic syndrome in women with PCOS. We will conclude with the importance of developing strategic interventions to increase the compliance to lifestyle and dietary modification, in addition to appreciation of the emerging pharmaceutical therapeutics available. Expert Opinion Innovation in lifestyle modification, including diet, exercise, with and without dedicated stress reduction techniques is the future in treatment of metabolic syndrome in PCOS. Application of novel interventions, such as group medical care, may improve future adherence to lifestyle modification recommendations, in addition to or in combination with pharmaceutical therapeutics.

Nutritional support and dietary interventions for women with polycystic ovary syndrome

“…38,48,49 Results from five meta-analyses of RCTs with women with PCOS supported the benefits of LSM programs on decreased BMI, fasting blood glucose, IR, FSH, sex hormone-binding globulin (SHBG), total testosterone, androstenedione, free androgen index (FAI) and Ferriman-Gallwey (FG) score and improved cardiorespiratory fitness, but not on glucose tolerance or lipid profiles. 57,63,[70][71][72] No studies have assessed the effects of LSM programs on clinical reproductive outcomes, quality of life or treatment satisfaction in women with PCOS.…”

“…5,[47][48][49][50] CC is the first-line therapy for ovulation induction in anovulatory infertile women with PCOS, although almost 20% of patients are unresponsive. 47,51 Results from a three-arm randomized, parallel, controlled, assessor-blinded clinical trial investigating the effects of a 6-week intervention with structured exercise training and hypocaloric diet on probability of ovulation after CC in overweight and obese CC-resistant PCOS women showed that structured exercise training combined with hypocaloric diet was effective in increasing the response to CC and the ovulation rate in overweight and obese PCOS patients.…”

“…15,16,48,49,58,[60][61][62][63][64] Results from a cross-sectional study showed that women with PCOS were more likely to follow a number of both healthy body weight management practices (balanced diet, reduced fat or sugar intake, adoption of a low-GI diet) as well as paradoxical nonhealthy attitudes (ie, increased smoking, use of laxative and diet pills) compared to women without PCOS. 65 Although most clinicians are in favor of lifestyle changes for the management of PCOS, the majority of women with PCOS reported that they rarely receive lifestyle advice from their therapists.…”

“…A team-based approach along with lifestyle interventions may be more suitable for the management and treatment of PCOS. 49,58,74,75 Negative energy balance and PCOS Several studies assessing the effects of caloric restriction along with modified dietary macronutrient composition on multiple health outcomes and biochemical indices have shown that there is no optimal dietary macronutrient composition or dietary pattern for PCOS. 38,41,76 Overall, there is little variation in weight loss with different diets, and this variation may be due to the differences in compliance and not how the body handles different macro-or micronutrients.…”

Diagnosis, Pathogenesis and Management of Polycystic Ovary Syndrome

“…In fact, PCOS is the most common cause of anovulatory infertility, the morphological changes may be genetic, but ovulation or anovulation is mainly dependent on the follicular environment, may be due to excessive production of local endocrine factor [18,28,29]. Hyperandrogenism is one of the diagnostic criteria of PCOS, and ovarian hyperandrogenism can lead to excessive follicular atresia, follicular stasis and anovulation.…”