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  • Vol 69, No 4 (2018) 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
Vol 69, No 4 (2018)
Guidelines / Expert consensus
Published online: 2018-08-21

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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

Andrzej Milewicz1, Marek Kudła2, Robert Z. Spaczyński3, Romuald Dębski4, Błażej Męczekalski5, Mirosław Wielgoś6, Marek Ruchała7, Ewa Małecka-Tendera8, Beata Kos-Kudła9, Diana Jędrzejuk1, Agnieszka Zachurzok10
DOI: 10.5603/EP.2018.0046
Pubmed: 30209800
Endokrynol Pol 2018;69(4):328-344.

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

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References

  1. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005; 352(12): 1223–1236.
    CrossRefPubMed
  2. 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.
    CrossRefPubMed
  3. Rogowicz-Frontczak A, Majchrzak A, Zozulińska-Ziółkiewicz D. Insulin resistance in endocrine disorders - treatment options. Endokrynol Pol. 2017; 68(3): 334–351.
    CrossRefPubMed
  4. 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.
    CrossRefPubMed
  5. 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.
    CrossRefPubMed
  6. 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.
    CrossRefPubMed
  7. 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.
    CrossRefPubMed
  8. 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.
    CrossRefPubMed
  9. 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].
    CrossRefPubMed
  10. 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.
    PubMed
  11. Hecht Baldauff N, Arslanian S. Optimal management of polycystic ovary syndrome in adolescence. Arch Dis Child. 2015; 100(11): 1076–1083.
    CrossRefPubMed
  12. 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.
    CrossRefPubMed
  13. Rosenfield RL. The Diagnosis of Polycystic Ovary Syndrome in Adolescents. Pediatrics. 2015; 136(6): 1154–1165.
    CrossRefPubMed
  14. Spritzer PM, Motta AB. Adolescence and polycystic ovary syndrome: current concepts on diagnosis and treatment. Int J Clin Pract. 2015; 69(11): 1236–1246.
    CrossRefPubMed
  15. Rothenberg SS, Beverley R, Barnard E, et al. Polycystic ovary syndrome in adolescents. Best Pract Res Clin Obstet Gynaecol. 2018; 48: 103–114.
    CrossRefPubMed
  16. 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.
    CrossRefPubMed
  17. 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.
    CrossRefPubMed
  18. 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.
    CrossRefPubMed
  19. Sultan C, Paris F. Clinical expression of polycystic ovary syndrome in adolescent girls. Fertil Steril. 2006; 86 Suppl 1: S6.
    CrossRefPubMed
  20. 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.
    CrossRefPubMed
  21. Witchel SF, Oberfield S, Rosenfield RL, et al. The Diagnosis of Polycystic Ovary Syndrome during Adolescence. Horm Res Paediatr. 2015 [Epub ahead of print].
    CrossRefPubMed
  22. 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.
    CrossRefPubMed
  23. 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.
    CrossRefPubMed
  24. 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.
    CrossRefPubMed
  25. 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.
    CrossRefPubMed
  26. 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.
    CrossRefPubMed
  27. Markopoulos MC, Kassi E, Alexandraki KI, et al. Hyperandrogenism after menopause. Eur J Endocrinol. 2015; 172(2): R79–R91.
    CrossRefPubMed
  28. Łebkowska A, Kowalska I. Anti-Müllerian hormone and polycystic ovary syndrome. Endokrynol Pol. 2017; 68: 74–78.
    CrossRef
  29. 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.
    CrossRefPubMed
  30. 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.
    CrossRefPubMed
  31. Pasquali R. Obesity and androgens: facts and perspectives. Fertil Steril. 2006; 85(5): 1319–1340.
    CrossRefPubMed
  32. Pasquali R, Gambineri A. Glucose intolerance states in women with the polycystic ovary syndrome. J Endocrinol Invest. 2013; 36(8): 648–653.
    CrossRefPubMed
  33. Villa J, Pratley RE. Adipose tissue dysfunction in polycystic ovary syndrome. Curr Diab Rep. 2011; 11(3): 179–184.
    CrossRefPubMed
  34. 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.
    CrossRefPubMed
  35. 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.
    CrossRefPubMed
  36. Diamanti-Kandarakis E, Papavassiliou AG, Kandarakis SA, et al. Pathophysiology and types of dyslipidemia in PCOS. Trends Endocrinol Metab. 2007; 18(7): 280–285.
    CrossRefPubMed
  37. 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.
    CrossRefPubMed
  38. 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.
    CrossRefPubMed
  39. 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.
    CrossRefPubMed
  40. Milewicz A, Silber D, Mielecki T. The origin of androgen synthesis in polycystic ovary syndrome. Obstet Gynecol. 1983; 62(5): 601–604.
    PubMed
  41. 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.
    CrossRefPubMed
  42. 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.
    CrossRefPubMed
  43. Wróbel MP, Marek B, Kajdaniuk D, et al. Metformin - a new old drug. Endokrynol Pol. 2017; 68(4): 482–496.
    CrossRefPubMed
  44. Wang YW, He SJ, Feng X, et al. Metformin: a review of its potential indications. Drug Des Devel Ther. 2017; 11: 2421–2429.
    CrossRefPubMed
  45. 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.
  46. Sam S, Ehrmann DA. Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome. Diabetologia. 2017; 60(9): 1656–1661.
    CrossRefPubMed
  47. Tsikouras P, Spyros L, Manav B, et al. Features of Polycystic Ovary Syndrome in adolescence. J Med Life. 2015; 8(3): 291–296.
    PubMed
  48. 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.
    CrossRefPubMed
  49. 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.
    CrossRefPubMed
  50. 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.
    CrossRef
  51. 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.
    CrossRefPubMed
  52. 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.
    CrossRefPubMed
  53. 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.
    CrossRefPubMed
  54. Milewicz A, Silber D, Kirschner MA. Therapeutic effects of spironolactone in polycystic ovary syndrome. Obstet Gynecol. 1983; 61(4): 429–432.
    PubMed
  55. 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.
    CrossRefPubMed
  56. Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril. 2008; 89(3): 505–522.
    CrossRefPubMed
  57. 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.
    CrossRefPubMed
  58. 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.
    CrossRefPubMed
  59. Pasquali R. Contemporary approaches to the management of polycystic ovary syndrome. Ther Adv Endocrinol Metab. 2018; 9(4): 123–134.
    CrossRefPubMed

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