Specificities of the treatment for polycystic ovary syndrome and metabolic syndrome
DOI: 10.32364/2618-8430-2020-3-4-254-259
I.Yu. Il’ina
N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation
This paper discusses polycystic ovary syndrome (PCOS), a common endocrine disorder characterized by hirsutism, anovulation, and polycystic ovaries. Insulin resistance which is considered the major causative factor for both PCOS and metabolic syndrome is emphasized. The early diagnosis of metabolic disorders which increase the risk of cardiovascular complications and the complications of pregnancy (including gestational diabetes and hypertension which may result in preeclampsia and placental abruption) is of particular importance. The presence of metabolic syndrome in PCOS is associated with poor prognosis in terms of fertility and has a negative impact on the outcomes of in vitro fertilization in infertile women with PCOS. When describing treatment approaches, the role of metformin, inositol, folates, vitamin D, and statins in treating metabolic disorders in PCOS and metabolic syndrome, reducing the risks of cardiovascular complications, and realizing fertile function is highlighted. The course of PCOS is complicated by psychic disorders (i.e., depression, anxiety, bipolar disorder, or eating disorders) which are common in these women and should be considered when prescribing medications.
Keywords: polycystic ovary syndrome, insulin resistance, infertility, metabolic syndrome, cardiovascular complications, inositol, folates.
For citation: Il’ina I.Yu. Specificities of the treatment for polycystic ovary syndrome and metabolic syndrome. Russian Journal of Woman and Child Health. 2020;3(4):254–259. DOI: 10.32364/2618-8430-2020-3-4-254-259.
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30. Monastra G., Unfer V., Harrath A.H., Bizzarri M. Combining treatment with myo-inositol and D-chiro-inositol (40:1) is effective in restoring ovary function and metabolic balance in PCOS patients. Gynecol Endocrinol. 2017;33(1):1–9. DOI: 10.1080/09513590. 2016.1247797.
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34. Januszewski M., Issat T., Jakimiuk A.A. et al. Metabolic and hormonal effects of a combined Myo-inositol and d-chiro-inositol therapy on patients with polycystic ovary syndrome (PCOS). Ginekol Pol. 2019;90(1):7–10. DOI: 10.5603/GP.2019.0002.
35. Fruzzetti F., Fidecicchi T., Palla G., Gambacciani M. Long-term treatment with alpha-lipoic acid and myo-inositol positively affects clinical and metabolic features of polycystic ovary syndrome. Gynecol Endocrinol. 2020;36(2):152–155. DOI: 10.1080/09513590.2019.1640673.
36. Rago R., Marcucci I., Leto G. et al. Effect of myo-inositol and alpha-lipoic acid on oocyte quality in polycystic ovary syndrome non-obese women undergoing in vitro fertilization: a pilot study. J Biol Regul Homeost Agents. 2015;29(4):913–923.
37. Genazzani A.D., Shefer K., Della Casa D. et al. Modulatory effects of alpha-lipoic acid (ALA) administration on insulin sensitivity in obese PCOS patients. J Endocrinol Invest. 2018;41(5):583–590. DOI: 10.1007/s40618-017-0782-z.
38. Artini P.G., Obino M.R., Micelli E. et al. Effect of d-chiro-inositol and alpha-lipoic acid combination on COH outcomes in overweight/obese PCOS women. Gynecol Endocrinol. 2020;36(9):755–759. DOI:10.1080/09513590.2020.1737007.
39. Trummer C., Schwetz V., Kollmann M. et al. Effects of vitamin D supplementation on metabolic and endocrine parameters in PCOS: a randomized-controlled trial. Eur J Nutr. 2019;58(5):2019–2028. DOI: 10.1007/s00394-018-1760-8.
40. Ostadmohammadi V., Jamilian M., Bahmani F., Asemi Z. Vitamin D and probiotic co-supplementation affects mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome. J Ovarian Res. 2019;12(1):5. DOI: 10.1186/s13048-019-0480-x.
41. Jamilian M., Mansury S., Bahmani F. et al. The effects of probiotic and selenium co-supplementation on parameters of mental health, hormonal profiles, and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome. J Ovarian Res. 2018;11(1):80. DOI: 10.1186/s13048-018-0457-1.
42. Eftekhar M., Mirhashemi E.S., Molaei B., Pourmasumi S. Is there any association between vitamin D levels and polycystic ovary syndrome (PCOS) phenotypes? Arch Endocrinol Metab. 2020;64(1):11–16. DOI: 10. 20945/2359-3997000000177.
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44. Christ J.P., Falcone T. Bariatric surgery improves hyperandrogenism, menstrual irregularities, and metabolic dysfunction among women with polycystic ovary syndrome (PCOS). Obes Surg. 2018;28(8):2171–2177. DOI: 10.1007/s11695-018-3155-6.
2. Meier R.K., Meier R.K. Polycystic Ovary Syndrome. Nurs Clin North Am. 2018;53(3):407420. DOI: 10.1016/j.cnur.2018.04.008.
3. Андреева Е.Н., Шереметьева Е.В., Дедов И.И. Синдром поликистозных яичников: этиология, патогенез, диагностика и лечение: научно-практическое руководство. М.: ВИДАР; 2016. [Andreeva E.N., Sheremetyeva E.V., Dedov I.I. Polycystic ovary syndrome: etiology, pathogenesis, diagnosis and treatment: scientific and practical guidance. M.: VIDAR; 2016 (in Russ.)].
4. Ali A.T. Polycystic ovary syndrome and metabolic syndrome. Ceska Gynekol. 2015;80(4):279–289.
5. Macut D., Bjekic-Macut J., Rahelic D., Doknic M. Insulin and the polycystic ovary syndrome. Diabetes Res Clin Pract. 2017;130:163–170. DOI: 10.1016/j. diabres.2017.06.011.
6. Норвиц Э.Р., Шордж Д.О. Наглядное акушерство и гинекология. Пер. с англ. М.: ГЭОТАР-Медиа; 2010:54–56. [Norvitz E.R., Shorj D.O. Visual obstetrics and gynecology. Translation from English. M.: GEOTAR-Media; 2010: 54–56 (in Russ.)].
7. Cooney L.G., Dokras A. Beyond fertility: polycystic ovary syndrome and long-term health. Fertil Steril. 2018;110(5):794–809. DOI: 10.1016/j. fertnstert.2018.08.021.
8. Brennan K.M., Kroener L.L., Chazenbalk G.D., Dumesic D.A. Polycystic Ovary Syndrome: Impact of Lipotoxicity on Metabolic and Reproductive Health. Obstet Gynecol Surv. 2019;74(4):223–231. DOI: 10.1097/ OGX.0000000000000661.
9. Azziz R. Polycystic ovary syndrome. Obstet Gynecol. 2018;132(2):321–336. DOI: 10.1097/ AOG.0000000000002698.
10. Sirmans S.M., Pate K.A. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013;6:1–13. DOI: 10.2147/CLEP.S37559.
11. Jeanes Y.M., Reeves S. Metabolic consequences of obesity and insulin resistance in polycystic ovary syndrome: diagnostic and methodological challenges. Nutr Res Rev. 2017;30(1):97–105. DOI: 10.1017/ S0954422416000287.
12. Nolan C.J., Prentki M. Insulin resistance and insulin hypersecretion in the metabolic syndrome and type 2 diabetes: Time for a conceptual framework shift. Diab Vasc Dis Res. 2019;16(2):118–127. DOI: 10.1177/ 1479164119827611.
13. Banuls C., Rovira-Llopis S., Martinez de Maranon A. et al. Metabolic syndrome enhances endoplasmic reticulum, oxidative stress and leukocyte-endothelium interactions in PCOS. Metabolism. 2017;71:153–162. DOI: 10.1016/ j.metabol.2017.02.012.
14. Croze M.L., Soulage C.O. Potential role and therapeutic interests of myo-inositol in metabolic diseases. Biochimie. 2013;95(10):1811–1827. DOI: 10.1016/ j.biochi.2013.05.011.
15. Chang H., Xie L., Ge H. et al. Effects of hyperhomocysteinaemia and metabolic syndrome on reproduction in women with polycystic ovary syndrome: a secondary analysis. Reprod Biomed Online. 2019;38(6):990–998. DOI: 10.1016/j.rbmo. 2018.12.046.
16. De Sousa S.M., Norman R.J. Metabolic syndrome, diet and exercise. Best Pract Res Clin Obstet Gynaecol. 2016;37:140–151. DOI: 10.1016/ j.bpobgyn.2016.01.006.
17. Otaghi M., Azami M., Khorshidi A. et al. The association between metabolic syndrome and polycystic ovary syndrome: A systematic review and meta-analysis. Diabetes Metab Syndr. 2019;13(2):1481–1489. DOI: 10.1016/ j.dsx.2019.01.002.
18. Lim S.S., Kakoly N.S., Tan J.W. et al. Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Obes Rev. 2019;20(2):339–352. DOI: 10.1111/obr.12762.
19. He Y., Lu Y., Zhu Q. et al. Influence of metabolic syndrome on female fertility and in vitro fertilization outcomes in PCOS women. Am J Obstet Gynecol. 2019;221(2):138.e1–138.e12. DOI: 10.1016/j.ajog.2019.03.011.
20. He C., Lin Z., Robb S.W., Ezeamama A.E. Serum Vitamin D Levels and Polycystic Ovary syndrome: A Systematic Review and Meta-Analysis. Nutrients. 2015;7(6):4555–4577. DOI: 10.3390/nu7064555.
21. Trummer C., Pilz S., Schwetz V. et al. Vitamin D, PCOS and androgens in men: a systematic review. Endocr Connect. 2018;7(3): R95–R113. DOI: 10.1530/EC-18-0009.
22. Krul-Poel Y.H., Koenders P.P., Steegers-Theunissen R.P. et al. Vitamin D and metabolic disturbances in polycystic ovary syndrome (PCOS): A cross-sectional study. PLoS One. 2018;13(12): e0204748. DOI: 10.1371/journal.pone.0204748.
23. Osibogun O., Ogunmoroti O., Michos E.D. Polycystic ovary syndrome and cardiometabolic risk: Opportunities for cardiovascular disease prevention. Trends Cardiovasc Med. 2020;30(7):399–404. DOI: 10.1016/ j.tcm.2019.08.010.
24. Клинические рекомендации. Синдром поликистозных яичников в репродуктивном возрасте (современные подходы к диагностике и лечению). 2015. [Clinical guidelines. Polycystic ovary syndrome in reproductive age (modern approaches to diagnosis and treatment). 2015 (in Russ.)].
25. Zhou J., Massey S., Story D., Li L. Metformin: an old drug with new applications. Int J Mol Sci. 2018;19(10):2863. DOI: 10.3390/ijms19102863.
26. Sam S., Ehrmann D.A. Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome. Diabetologia. 2017;60(9):1656–1661. DOI: 10.1007/s00125-017-4306-3.
27. Saleem F., Rizvi S.W. New Therapeutic Approaches in Obesity and Metabolic Syndrome Associated with Polycystic Ovary Syndrome. Cureus. 2017;9(11): e1844. DOI: 10.7759/cureus.1844.
28. Pizzo A., Lagana A.S., Barbaro L. Comparison between effects of myo-inositol and D-chiro-inositol on ovarian function and metabolic factors in women with PCOS. Gynecol Endocrinol. 2014;30(3):205–208. DOI: 10.3109/ 09513590.2013.860120.
29. Garg D., Tal R. Inositol Treatment and ART Outcomes in Women with PCOS. Int J Endocrinol. 2016;2016:1979654. DOI: 10.1155/2016/1979654.
30. Monastra G., Unfer V., Harrath A.H., Bizzarri M. Combining treatment with myo-inositol and D-chiro-inositol (40:1) is effective in restoring ovary function and metabolic balance in PCOS patients. Gynecol Endocrinol. 2017;33(1):1–9. DOI: 10.1080/09513590. 2016.1247797.
31. Regidor P.A., Schindler A.E., Lesoine B., Druckman R. Management of women with PCOS using myo-inositol and folic acid. New clinical data and review of the literature. Horm Mol Biol Clin Investig. 2018;34(2):/j/hmbci.2018.34.issue-2/hmbci-2017–0067/hmbci-2017–0067.xml. DOI: 10.1515/hmbci-2017-0067.
32. Fruzzetti F., Perini D., Russo M. et al. Comparison of two insulin sensitizers, metformin and myo-inositol, in women with polycystic ovary syndrome (PCOS). Gynecol Endocrinol. 2017;33(1):39–42. DOI: 10.1080/09513590.2016.1236078.
33. Roseff S., Montenegro M. Inositol Treatment for PCOS Should Be Science-Based and Not Arbitrary. Int J Endocrinol. 2020;2020:6461254. DOI: 10.1155/2020/ 6461254.
34. Januszewski M., Issat T., Jakimiuk A.A. et al. Metabolic and hormonal effects of a combined Myo-inositol and d-chiro-inositol therapy on patients with polycystic ovary syndrome (PCOS). Ginekol Pol. 2019;90(1):7–10. DOI: 10.5603/GP.2019.0002.
35. Fruzzetti F., Fidecicchi T., Palla G., Gambacciani M. Long-term treatment with alpha-lipoic acid and myo-inositol positively affects clinical and metabolic features of polycystic ovary syndrome. Gynecol Endocrinol. 2020;36(2):152–155. DOI: 10.1080/09513590.2019.1640673.
36. Rago R., Marcucci I., Leto G. et al. Effect of myo-inositol and alpha-lipoic acid on oocyte quality in polycystic ovary syndrome non-obese women undergoing in vitro fertilization: a pilot study. J Biol Regul Homeost Agents. 2015;29(4):913–923.
37. Genazzani A.D., Shefer K., Della Casa D. et al. Modulatory effects of alpha-lipoic acid (ALA) administration on insulin sensitivity in obese PCOS patients. J Endocrinol Invest. 2018;41(5):583–590. DOI: 10.1007/s40618-017-0782-z.
38. Artini P.G., Obino M.R., Micelli E. et al. Effect of d-chiro-inositol and alpha-lipoic acid combination on COH outcomes in overweight/obese PCOS women. Gynecol Endocrinol. 2020;36(9):755–759. DOI:10.1080/09513590.2020.1737007.
39. Trummer C., Schwetz V., Kollmann M. et al. Effects of vitamin D supplementation on metabolic and endocrine parameters in PCOS: a randomized-controlled trial. Eur J Nutr. 2019;58(5):2019–2028. DOI: 10.1007/s00394-018-1760-8.
40. Ostadmohammadi V., Jamilian M., Bahmani F., Asemi Z. Vitamin D and probiotic co-supplementation affects mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome. J Ovarian Res. 2019;12(1):5. DOI: 10.1186/s13048-019-0480-x.
41. Jamilian M., Mansury S., Bahmani F. et al. The effects of probiotic and selenium co-supplementation on parameters of mental health, hormonal profiles, and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome. J Ovarian Res. 2018;11(1):80. DOI: 10.1186/s13048-018-0457-1.
42. Eftekhar M., Mirhashemi E.S., Molaei B., Pourmasumi S. Is there any association between vitamin D levels and polycystic ovary syndrome (PCOS) phenotypes? Arch Endocrinol Metab. 2020;64(1):11–16. DOI: 10. 20945/2359-3997000000177.
43. Прегравидарная подготовка. Клинический протокол. Междисциплинарная ассоциация специалистов репродуктивной медицины. М.; 2016. [Pregravid preparation. Clinical protocol. Interdisciplinary Association of Reproductive Medicine Professionals. M.; 2016 (in Russ.)].
44. Christ J.P., Falcone T. Bariatric surgery improves hyperandrogenism, menstrual irregularities, and metabolic dysfunction among women with polycystic ovary syndrome (PCOS). Obes Surg. 2018;28(8):2171–2177. DOI: 10.1007/s11695-018-3155-6.
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