Polski
The polycystic ovary syndrome: a position statement from the Polish Society of Endocrinology, the Polish Society of Gynaecologists and Obstetricians, and the Polish Society of Gynaecological Endocrinology
Abstract
Polycystic ovary syndrome (PCOS) diagnosis and therapy still arouse a lot of controversy. Each year brings new information, so, having collected the experience of three scientific societies, we present contemporary recommendations concerning PCOS diagnostics and treatment. In adult female diagnosis, we still use the Rotterdam criteria, which is two out of three of the follwing characteristics: a) ovulation abnormality, b) clinical or biochemical hyperandrogenism, and c) polycystic ovaries. In the case of teenagers, diagnostic criteria are as follows: menstruation disturbances two years after menarche and clinical or biochemical hyperandrogenism. The presence of polycystically abnormal ovaries is not necessary. The consensus paper presents the threats resulting from imperfect diagnostic methods applied in PCOS (hyperandrogenism diagnostics, ultrasound examination of ovaries). Suggested therapy includes personalised schemes according to the dominant PCOS phenotype, i.e. metabolic, hyperandrogenic, or reproductive ones.
Keywords: polycystic ovary syndromediagnosis of PCOSPCOS phenotypespersonalised therapy
References
- Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005; 352(12): 1223–1236.
- Conway G, Dewailly D, Diamanti-Kandarakis E, et al. ESE PCOS Special Interest Group. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol. 2014; 171(4): P1–29.
- Rogowicz-Frontczak A, Majchrzak A, Zozulińska-Ziółkiewicz D. Insulin resistance in endocrine disorders - treatment options. Endokrynol Pol. 2017; 68(3): 334–351.
- Diamanti-Kandarakis E, Piperi C, Korkolopoulou P, et al. Accumulation of dietary glycotoxins in the reproductive system of normal female rats. J Mol Med (Berl). 2007; 85(12): 1413–1420.
- Merhi Z, Irani M, Doswell AD, et al. Follicular fluid soluble receptor for advanced glycation end-products (sRAGE): a potential indicator of ovarian reserve. J Clin Endocrinol Metab. 2014; 99(2): E226–E233.
- Kandaraki E, Chatzigeorgiou A, Livadas S, et al. Endocrine disruptors and polycystic ovary syndrome (PCOS): elevated serum levels of bisphenol A in women with PCOS. J Clin Endocrinol Metab. 2011; 96(3): E480–E484.
- Rutkowska A, Rachoń D, Milewicz A, et al. Polish Society of Endocrinology Position statement on endocrine disrupting chemicals (EDCs). Endokrynol Pol. 2015; 66(3): 276–281.
- Akın L, Kendirci M, Narin F, et al. The endocrine disruptor bisphenol A may play a role in the aetiopathogenesis of polycystic ovary syndrome in adolescent girls. Acta Paediatr. 2015; 104(4): e171–e177.
- Savic-Radojevic A, Mazibrada I, Djukic T, et al. Glutathione S-transferases (GSTs) polymorphism could be an early marker in the development of PCOS: an insight from non-obese and non-insulin resistant adolescents. Endokrynol Pol. 2018 [Epub ahead of print].
- 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(1): 41–47.
- Hecht Baldauff N, Arslanian S. Optimal management of polycystic ovary syndrome in adolescence. Arch Dis Child. 2015; 100(11): 1076–1083.
- Ibáñez L, Oberfield SE, Witchel S, et al. An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence. Horm Res Paediatr. 2017; 88(6): 371–395.
- Rosenfield RL. The Diagnosis of Polycystic Ovary Syndrome in Adolescents. Pediatrics. 2015; 136(6): 1154–1165.
- Spritzer PM, Motta AB. Adolescence and polycystic ovary syndrome: current concepts on diagnosis and treatment. Int J Clin Pract. 2015; 69(11): 1236–1246.
- Rothenberg SS, Beverley R, Barnard E, et al. Polycystic ovary syndrome in adolescents. Best Pract Res Clin Obstet Gynaecol. 2018; 48: 103–114.
- Goodman NF, Cobin RH, Futterweit W, et al. American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE), Androgen Excess and PCOS Society (AES). AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ANDROGEN EXCESS AND PCOS SOCIETY DISEASE STATE CLINICAL REVIEW: GUIDE TO THE BEST PRACTICES IN THE EVALUATION AND TREATMENT OF POLYCYSTIC OVARY SYNDROME--PART 1. Endocr Pract. 2015; 21(11): 1291–1300.
- Hickey M, Doherty DA, Atkinson H, et al. Clinical, ultrasound and biochemical features of polycystic ovary syndrome in adolescents: implications for diagnosis. Hum Reprod. 2011; 26(6): 1469–1477.
- Carmina E, Oberfield SE, Lobo RA. The diagnosis of polycystic ovary syndrome in adolescents. Am J Obstet Gynecol. 2010; 203(3): 201.e1–201.e5.
- Sultan C, Paris F. Clinical expression of polycystic ovary syndrome in adolescent girls. Fertil Steril. 2006; 86 Suppl 1: S6.
- Morris S, Grover S, Sabin MA. What does a diagnostic label of 'polycystic ovary syndrome' really mean in adolescence? A review of current practice recommendations. Clin Obes. 2016; 6(1): 1–18.
- Witchel SF, Oberfield S, Rosenfield RL, et al. The Diagnosis of Polycystic Ovary Syndrome during Adolescence. Horm Res Paediatr. 2015 [Epub ahead of print].
- Wild RA, Vesely S, Beebe L, et al. Ferriman Gallwey self-scoring I: performance assessment in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005; 90(7): 4112–4114.
- Azziz R, Sanchez LA, Knochenhauer ES, et al. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab. 2004; 89(2): 453–462.
- Escobar-Morreale HF, Carmina E, Dewailly D, et al. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2012; 18(2): 146–170.
- Gambineri A, Fanelli F, Prontera O, et al. Prevalence of hyperandrogenic states in late adolescent and young women: epidemiological survey on italian high-school students. J Clin Endocrinol Metab. 2013; 98(4): 1641–1650.
- Pasquali R, Zanotti L, Fanelli F, et al. Defining Hyperandrogenism in Women With Polycystic Ovary Syndrome: A Challenging Perspective. J Clin Endocrinol Metab. 2016; 101(5): 2013–2022.
- Markopoulos MC, Kassi E, Alexandraki KI, et al. Hyperandrogenism after menopause. Eur J Endocrinol. 2015; 172(2): R79–R91.
- Łebkowska A, Kowalska I. Anti-Müllerian hormone and polycystic ovary syndrome. Endokrynol Pol. 2017; 68: 74–78.
- Catteau-Jonard S, Bancquart J, Poncelet E, et al. Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? Ultrasound Obstet Gynecol. 2012; 40(2): 223–229.
- Dewailly D, Lujan ME, Carmina E, et al. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2014; 20(3): 334–352.
- Pasquali R. Obesity and androgens: facts and perspectives. Fertil Steril. 2006; 85(5): 1319–1340.
- Pasquali R, Gambineri A. Glucose intolerance states in women with the polycystic ovary syndrome. J Endocrinol Invest. 2013; 36(8): 648–653.
- Villa J, Pratley RE. Adipose tissue dysfunction in polycystic ovary syndrome. Curr Diab Rep. 2011; 11(3): 179–184.
- Macut D, Tziomalos K, Božić-Antić I, et al. Non-alcoholic fatty liver disease is associated with insulin resistance and lipid accumulation product in women with polycystic ovary syndrome. Hum Reprod. 2016; 31(6): 1347–1353.
- Macut D, Panidis D, Glisić B, et al. Lipid and lipoprotein profile in women with polycystic ovary syndrome. Can J Physiol Pharmacol. 2008; 86(4): 199–204.
- Diamanti-Kandarakis E, Papavassiliou AG, Kandarakis SA, et al. Pathophysiology and types of dyslipidemia in PCOS. Trends Endocrinol Metab. 2007; 18(7): 280–285.
- Hudecova M, Holte J, Olovsson M, et al. Prevalence of the metabolic syndrome in women with a previous diagnosis of polycystic ovary syndrome: long-term follow-up. Fertil Steril. 2011; 96(5): 1271–1274.
- Derksen J, Nagesser SK, Meinders AE, et al. Identification of virilizing adrenal tumors in hirsute women. N Engl J Med. 1994; 331(15): 968–973.
- Pascale MM, Pugeat M, Roberts M, et al. Androgen suppressive effect of GnRH agonist in ovarian hyperthecosis and virilizing tumours. Clin Endocrinol (Oxf). 1994; 41(5): 571–576.
- Milewicz A, Silber D, Mielecki T. The origin of androgen synthesis in polycystic ovary syndrome. Obstet Gynecol. 1983; 62(5): 601–604.
- Puurunen J, Piltonen T, Jaakkola P, et al. Adrenal androgen production capacity remains high up to menopause in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2009; 94(6): 1973–1978.
- Ayyad C, Andersen T. Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999. Obes Rev. 2000; 1(2): 113–119.
- Wróbel MP, Marek B, Kajdaniuk D, et al. Metformin - a new old drug. Endokrynol Pol. 2017; 68(4): 482–496.
- Wang YW, He SJ, Feng X, et al. Metformin: a review of its potential indications. Drug Des Devel Ther. 2017; 11: 2421–2429.
- Castillo J. Metformin in the management of polycystic ovary syndrome. In: Metformin-60 years of clinical experience for the better tomorrow. Monography - copywright 2017: 79–91.
- Sam S, Ehrmann DA. Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome. Diabetologia. 2017; 60(9): 1656–1661.
- Tsikouras P, Spyros L, Manav B, et al. Features of Polycystic Ovary Syndrome in adolescence. J Med Life. 2015; 8(3): 291–296.
- Al-Ruthia YS, Al-Mandeel H, AlSanawi H, et al. Ovulation induction by metformin among obese versus non-obese women with polycystic ovary syndrome. Saudi Pharm J. 2017; 25(5): 795–800.
- Naderpoor N, Shorakae S, de Courten B, et al. Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis. Hum Reprod Update. 2016; 22(3): 408–409.
- Khalifah RAAl, Florez ID, Dennis B, et al. Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis. PEDIATRICS. 2016; 137(5): e20154089–e20154089.
- Practice Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrm.org, Practice Committee of the American Society for Reproductive Medicine. Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline. Fertil Steril. 2017; 108(3): 426–441.
- Laganà AS, Rossetti P, Sapia F, et al. Evidence-Based and Patient-Oriented Inositol Treatment in Polycystic Ovary Syndrome: Changing the Perspective of the Disease. Int J Endocrinol Metab. 2017; 15(1): e43695.
- Jensterle Sever M, Kocjan T, Pfeifer M, et al. Short-term combined treatment with liraglutide and metformin leads to significant weight loss in obese women with polycystic ovary syndrome and previous poor response to metformin. Eur J Endocrinol. 2014; 170(3): 451–459.
- Milewicz A, Silber D, Kirschner MA. Therapeutic effects of spironolactone in polycystic ovary syndrome. Obstet Gynecol. 1983; 61(4): 429–432.
- Zhang J, Si Q, Li J. Therapeutic effects of metformin and clomiphene in combination with lifestyle intervention on infertility in women with obese polycystic ovary syndrome. Pak J Med Sci. 2017; 33(1): 8–12.
- Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril. 2008; 89(3): 505–522.
- Morgante G, Massaro MG, Di Sabatino A, et al. Therapeutic approach for metabolic disorders and infertility in women with PCOS. Gynecol Endocrinol. 2018; 34(1): 4–9.
- Legro RS, Brzyski RG, Diamond MP, et al. NICHD Reproductive Medicine Network. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014; 371(2): 119–129.
- Pasquali R. Contemporary approaches to the management of polycystic ovary syndrome. Ther Adv Endocrinol Metab. 2018; 9(4): 123–134.