Update on PCOS: Consequences, Challenges, and Guiding Treatment

Abstract

Polycystic Ovary Syndrome (PCOS) is one of the most common reproductive endocrine disorders in women and despite this, diagnostic challenges, delayed diagnosis and less than optimal treatment regimens plague the condition. The International PCOS network, consisting of geographically diverse international experts in PCOS as well as consumers, engaged in a multi-year international evidence-based guideline development process that was jointly sponsored by the European Society for Human Reproduction and Embryology (ESHRE) and the American Society of Reproductive Medicine (ASRM). The guideline was published in 2018 and endorsed by more than 40 international societies involved in PCOS. Translation of this evidence-based guideline to medical practice and consumer groups remains a priority. However, there remain many challenges to both understanding the diagnosis and treatment of PCOS. Evidence suggests that both clinicians and consumers are not satisfied with the timeliness of diagnosis and treatment options. This review summarizes the important findings for diagnosis and treatment from the guidelines and expands on recent developments in the literature since its publication. Special attention to diagnosis at the ends of the reproductive spectrum are discussed and remaining areas of controversy are noted. Additionally, the review highlights some of the remaining challenges in the understanding and management of PCOS to help guide clinicians and investigators in this perplexing condition.

Increased uterine androgen receptor protein abundance results in implantation and mitochondrial defects in pregnant rats with hyperandrogenism and insulin resistance

“…Polycystic ovary syndrome (PCOS) is one of the most common gynecological disorders associated with fertility difficulties, and it affects 5-25% of all adolescent and reproductive-aged women across multiple geographic ancestries and ethnicities [1][2][3]. It has a multifactorial etiology and is characterized by reproductive dysfunction accompanied by metabolic abnormalities, and women with PCOS have an increased risk for pregnancy-related complications [4][5][6].…”

Effectiveness of a 6-Month Lifestyle Intervention on Diet, Physical Activity, Quality of Life, and Markers of Cardiometabolic Health in Women with PCOS and Obesity and Non-PCOS Obese Controls: One Size Fits All?

“…Lifestyle interventions leading to 5-10% weight loss may reverse anovulatory status, thereby increasing natural conception rates [1,4]. Moderate weight loss may also improve insulin resistance, dyslipidemia, and androgen excess in PCOS [5].…”

ANGPTL4 expression in ovarian granulosa cells is associated with polycystic ovary syndrome

“…As we all know, Polycystic ovary syndrome (PCOS) is a highly heterogeneous endocrine disorder characterized by hyperandrogen, rare ovulation and polycystic ovary, and its pathogenesis is debated [14][15][16] .Previous studies have demonstrated that the core etiology and primary endocrine characteristics of PCOS are insulin resistance (IR) and hyperandrogenemia (HA), and they can interplay each other leading to metabolic syndrome, especially dyslipidemia [17][18][19][20][21] . AMH are often used as clinical observation indicators reflecting the ovarian reserve 22,23 , and the LH/FSH and T levels were significantly higher in PCOS patients compared with control patients 24,25 .Compared with those characteristics related to PCOS, the expression level of ANGPTL4 in ovarian GCs might be a independent factor which affected incidence of PCOS and could serve as a new predictor for PCOS according to results of ROC cure and binary logistic regression analysis.…”