Recent advances in the understanding and management of polycystic ovary syndrome

F1000Res. 2019 Apr 26;8:F1000 Faculty Rev-565. doi: 10.12688/f1000research.15318.1. eCollection 2019.

Abstract

Polycystic ovary syndrome (PCOS) is a multifaceted condition characterized by chronic anovulation and excess ovarian activity, in contrast to other causes of anovulation that involve ovarian dormancy or primary insufficiency. Recent studies indicated that PCOS is associated with low-grade chronic inflammation and that women with PCOS are at increased risk of non-alcoholic fatty liver disease. The inflammatory and metabolic derangements associated with PCOS are explained in part by the coexistence of insulin resistance and obesity but are further fueled by the androgen excess. New insights into the regulation of hormones and cytokines in muscle and fat tissue support the concept that PCOS is a systemic syndrome. The therapeutic plan should be tailored to the patient phenotype, complaints, and reproductive desire. Of note, the aromatase inhibitor letrozole seems to be more effective than the reference drug clomiphene citrate to treat infertility due to PCOS. Integral management by a multidisciplinary team may help the patients to adhere to lifestyle interventions and thereby reduce body adiposity and recover their metabolic and reproductive health.

Keywords: PCOS; infertility; insulin resistance; menstrual irregularity; polycystic ovary syndrome.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aromatase Inhibitors / therapeutic use
  • Clomiphene / therapeutic use
  • Female
  • Humans
  • Insulin Resistance*
  • Letrozole / therapeutic use
  • Obesity / complications*
  • Polycystic Ovary Syndrome / complications
  • Polycystic Ovary Syndrome / therapy*

Substances

  • Aromatase Inhibitors
  • Clomiphene
  • Letrozole

Grant support

This research was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (National Council for Scientific and Technological Development).