Recent Advances in the Management of Polycystic Ovary Syndrome

Kim, Chung Hoon

Abstract

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women, and the most frequent cause of anovulatory infertility with high circulating levels of luteinizing hormone (LH), chronic hyperandrogenemia, and insulin resistance. PCOS is a heterogeneous disorder with a broad spectrum of clinical manifestations. PCOS patients with chronic anovulation or hyperandrogenism or insulin resistance develop clinical problems. Therefore, appropriate tailored therapeutic management is essential for them, and a multidisciplinary approach is frequently needed. The aim of treatment in PCOS is for (1) improvement of endocrine-metabolic derangement and prevention of consequences of metabolic sequelae (cardiovascular disease, DM), (2) protection of endometrium against the effects of unopposed estrogen, (3) symptomatic treatment such as control of DUB, (4) cosmetic effects such as improvement of acne, hirsutism and achievement of normal body weight, (5) ovulation induction to achieve pregnancy in infertile PCOS women. Therefore, we should try to (1) improve hyperinsulinemia and/or avoid the effects of hyperinsulinemia, (2) reduce the production and circulating levels of androgens, (3) supplement progestins periodically, and (4) induce the ovulation in women desiring pregnancy. The specific treatment depends on a patient's goals and characteristics. Weight reduction and therapies with insulin sensitizing drugs should be considered as a primary treatment in obese PCOS women irrespective of patient's goals. In PCOS patients desiring pregnancy, appropriate algorithm for ovulation induction should be considered before starting the ovulation induction. Once ovulation has been documented for a particular therapy, patients should be mentally prepared to continue with that regimen for at least three cycles. The management plan for patients should be reviewed at least once every 3 cycles and more frequently if complications or abnormal ovarian responses are present. A better understanding of the pathogenesis of PCOS leads to novel therapies. We are actually entering a new era in management of PCOS women. Important benefits will be derived from the long-term aggressive preventive health care attitude in PCOS women with obesity, insulin resistance and/or chronic anovulation.