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Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Repurposing.International Journal of Molecular... Jan 2022Polycystic ovary syndrome (PCOS) is an endocrine-gynecology disorder affecting many women of childbearing age. Although a part of the involved mechanism in PCOS... (Review)
Review
Polycystic ovary syndrome (PCOS) is an endocrine-gynecology disorder affecting many women of childbearing age. Although a part of the involved mechanism in PCOS occurrence is discovered, the exact etiology and pathophysiology are not comprehensively understood yet. We searched PubMed for PCOS pathogenesis and management in this article and ClinicalTrials.gov for information on repurposed medications. All responsible factors behind PCOS were thoroughly evaluated. Furthermore, the complete information on PCOS commonly prescribed and repurposed medications is summarized through tables. Epigenetics, environmental toxicants, stress, diet as external factors, insulin resistance, hyperandrogenism, inflammation, oxidative stress, and obesity as internal factors were investigated. Lifestyle modifications and complementary and alternative medicines are preferred first-line therapy in many cases. Medications, including 3-hydroxy-3-methyl-3-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors, thiazolidinediones, sodium-glucose cotransporter-2 inhibitors, dipeptidyl peptidase-4 inhibitors, glucose-like peptide-1 receptor agonists, mucolytic agents, and some supplements have supporting data for being repurposed in PCOS. Since there are few completed clinical trials with a low population and mostly without results on PCOS repurposed medications, it would be helpful to do further research and run well-designed clinical trials on this subject. Moreover, understanding more about PCOS would be beneficial to find new medications implying the effect via the novel discovered routes.
Topics: Disease Management; Drug Repositioning; Female; Humans; Hyperandrogenism; Insulin Resistance; Polycystic Ovary Syndrome
PubMed: 35054768
DOI: 10.3390/ijms23020583 -
Nature Reviews. Endocrinology May 2018Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders in premenopausal women. Heterogeneous by nature, PCOS is defined by a... (Review)
Review
Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders in premenopausal women. Heterogeneous by nature, PCOS is defined by a combination of signs and symptoms of androgen excess and ovarian dysfunction in the absence of other specific diagnoses. The aetiology of this syndrome remains largely unknown, but mounting evidence suggests that PCOS might be a complex multigenic disorder with strong epigenetic and environmental influences, including diet and lifestyle factors. PCOS is frequently associated with abdominal adiposity, insulin resistance, obesity, metabolic disorders and cardiovascular risk factors. The diagnosis and treatment of PCOS are not complicated, requiring only the judicious application of a few well-standardized diagnostic methods and appropriate therapeutic approaches addressing hyperandrogenism, the consequences of ovarian dysfunction and the associated metabolic disorders. This article aims to provide a balanced review of the latest advances and current limitations in our knowledge about PCOS while also providing a few clear and simple principles, based on current evidence-based clinical guidelines, for the proper diagnosis and long-term clinical management of women with PCOS.
Topics: Animals; Female; Humans; Hyperandrogenism; Insulin Resistance; Metabolic Diseases; Obesity; Polycystic Ovary Syndrome
PubMed: 29569621
DOI: 10.1038/nrendo.2018.24 -
Nutrients Jul 2021Here we present an extensive narrative review of the broadly understood modifications to the lifestyles of women with polycystic ovary syndrome (PCOS). The PubMed... (Review)
Review
Here we present an extensive narrative review of the broadly understood modifications to the lifestyles of women with polycystic ovary syndrome (PCOS). The PubMed database was analyzed, combining PCOS entries with causes, diseases, diet supplementation, lifestyle, physical activity, and use of herbs. The metabolic pathways leading to disturbances in lipid, carbohydrate, and hormonal metabolism in targeted patients are described. The article refers to sleep disorders, changes in mental health parameters, and causes of oxidative stress and inflammation. These conditions consistently lead to the occurrence of severe diseases in patients suffering from diabetes, the fatty degeneration of internal organs, infertility, atherosclerosis, cardiovascular diseases, dysbiosis, and cancer. The modification of lifestyles, diet patterns and proper selection of nutrients, pharmacological and natural supplementation in the form of herbs, and physical activity have been proposed. The progress and consequences of PCOS are largely modifiable and depend on the patient's approach, although we have to take into account also the genetic determinants.
Topics: Diet; Dietary Supplements; Dysbiosis; Exercise; Female; Gastrointestinal Microbiome; Humans; Life Style; Metabolic Networks and Pathways; Plants, Medicinal; Polycystic Ovary Syndrome; Sleep
PubMed: 34371961
DOI: 10.3390/nu13072452 -
Fertility and Sterility Jul 2016Polycystic ovary syndrome (PCOS) is a highly prevalent disorder effecting reproductive-aged women worldwide. This article addresses the evolution of the criteria used to... (Review)
Review
Polycystic ovary syndrome (PCOS) is a highly prevalent disorder effecting reproductive-aged women worldwide. This article addresses the evolution of the criteria used to diagnosis PCOS; reviews recent advances in the phenotypic approach, specifically in the context of the extended Rotterdam criteria; discusses limitations of the current criteria used to diagnosis, particularly when studying adolescents and women in the peri- and postmenopause; and describes significant strides made in understanding the epidemiology of PCOS. This review recognizes that although there is a high prevalence of PCOS, there is increased variability when using Rotterdam 2003 criteria, owing to limitations in population sampling and approaches used to define PCOS phenotypes. Last, we discuss the distribution of PCOS phenotypes, their morbidity, and the role that referral bias plays in the epidemiology of this syndrome.
Topics: Adolescent; Adult; Age Distribution; Age of Onset; Female; Humans; Phenotype; Polycystic Ovary Syndrome; Predictive Value of Tests; Prevalence; Referral and Consultation; Reproduction; Reproductive Health; Risk Factors; Selection Bias; Young Adult
PubMed: 27233760
DOI: 10.1016/j.fertnstert.2016.05.003 -
The Journal of Steroid Biochemistry and... Sep 2018Polycystic ovary syndrome (PCOS) is an endocrine disorder, afflicting females of reproductive age. This syndrome leads to infertility, insulin resistance, obesity, and... (Review)
Review
Polycystic ovary syndrome (PCOS) is an endocrine disorder, afflicting females of reproductive age. This syndrome leads to infertility, insulin resistance, obesity, and cardiovascular problems, including a litany of other health issues. PCOS is a polygenic, polyfactorial, systemic, inflammatory, dysregulated steroid state, autoimmune disease, manifesting largely due to lifestyle errors. The advent of biochemical tests and ultrasound scanning has enabled the detection of PCOS in the affected females. Subsequently, a huge amount of insight on PCOS has been garnered in recent times. Interventions like oral contraceptive pills, metformin, and hormone therapy have been developed to bypass or reverse the ill effects of PCOS. However, lifestyle correction to prevent aberrant immune activation and to minimize the exposure to inflammatory agents, appears to be the sustainable therapy of PCOS. This holistic review with multiple hypotheses might facilitate to devise better PCOS management approaches.
Topics: Endocrine System; Female; Humans; Inflammation; Insulin Resistance; Life Style; Obesity; Polycystic Ovary Syndrome
PubMed: 29678491
DOI: 10.1016/j.jsbmb.2018.04.008 -
Medicina Clinica Jun 2019Polycystic ovary syndrome is the most prevalent endocrine-metabolic pathology in pre-menopausal women. Its etiopathogenesis is complex, multifactorial and heterogeneous,... (Review)
Review
Polycystic ovary syndrome is the most prevalent endocrine-metabolic pathology in pre-menopausal women. Its etiopathogenesis is complex, multifactorial and heterogeneous, including the interaction of genetic, epigenetic and environmental factors. Androgenic excess constitutes the disease's main physiopathological mechanism and results in reproductive, metabolic and cosmetic alterations which negatively impact these patients' quality of life. The criteria established in the Rotterdam consensus and their correct application form the necessary basis for this syndrome's proper diagnosis. In the absence of an aetiological treatment, the aim is to improve the clinical signs and symptoms derived from hyperandrogenism, ovarian dysfunction and existing metabolic complications, and, therefore, they must be chronic and individualised.
Topics: Adult; Anovulation; Comorbidity; Female; Hirsutism; Humans; Hyperandrogenism; Infertility; Obesity; Polycystic Ovary Syndrome; Quality of Life
PubMed: 30616916
DOI: 10.1016/j.medcli.2018.11.019 -
The Nursing Clinics of North America Sep 2018Polycystic ovary syndrome (PCOS) is a commonly occurring endocrine disorder characterized by hirsutism, anovulation, and polycystic ovaries. Often comorbid with insulin... (Review)
Review
Polycystic ovary syndrome (PCOS) is a commonly occurring endocrine disorder characterized by hirsutism, anovulation, and polycystic ovaries. Often comorbid with insulin resistance, dyslipidemia, and obesity, it also carries significant risk for the development of cardiovascular and metabolic sequelae, including diabetes and metabolic syndrome. Traditionally, the treatment of patients with PCOS has focused on relief of symptoms. Here, the criteria for the diagnosis of PCOS are reviewed with an emphasis on the stratification of subtypes by metabolic features. Then treatment options are reviewed according to the management goal: relief of hyperandrogenic symptoms, regulation of menstruation, and restoration of fertility.
Topics: Female; Humans; Polycystic Ovary Syndrome; Women's Health Services
PubMed: 30100006
DOI: 10.1016/j.cnur.2018.04.008 -
Journal of Food Biochemistry Jul 2022Polycystic ovarian syndrome (PCOS) is caused by abnormal production of androgens resulting in the formation of small fluid-filled sacs in the ovaries. This condition... (Review)
Review
Polycystic ovarian syndrome (PCOS) is caused by abnormal production of androgens resulting in the formation of small fluid-filled sacs in the ovaries. This condition worsens the life quality of women by disturbing their physiology and psychology in reproductive age. PCOS may also be associated with other morbidities like diabetes and hypertension. Numerous factors like imbalanced dietary patterns, poor lifestyle activities, improper care and medication, late diagnosis, and ignorance are involved in the prevalence of this disease in women. Hence, an early diagnosis and improved dietary and lifestyle management may improve the life quality and timely recovery of the patient from this disease. Various herbal extracts show a positive correlation in reducing the indicators associated with PCOS. This review discusses the effect of dietary and lifestyle practices on PCOS as prominent features. It has been recommended that a balanced diet with 40% energy from carbohydrates, 30% from fats, and 30% from protein with optimum physical activity could reduce severe PCOS symptoms and improve metabolic balance. Furthermore, recommendations for modification of diet and lifestyle activities are made which may positively influence the recovery from PCOS. PRACTICAL APPLICATIONS: Polycystic ovarian syndrome (PCOS) severely affects the life quality of suffering women. The dietary patterns, lifestyle activities, and co-medical conditions collectively affect the severity and related consequences of PCOS. This article provides sufficient information on dietary and lifestyle modifications to effectively manage this disease. Furthermore, dietitians, nutritionists, gynecologists, and obstetrics physicians can benefit from the information provided in it to understand and develop the management strategies to alleviate the disease symptoms and severity.
Topics: Diet; Female; Humans; Life Style; Polycystic Ovary Syndrome; Pregnancy
PubMed: 35199348
DOI: 10.1111/jfbc.14117 -
The New England Journal of Medicine Jul 2016A 22-year-old woman reports having hirsutism and irregular menses. She describes unpredictable and infrequent menses (five or six per year) since menarche at 11 years of... (Review)
Review
A 22-year-old woman reports having hirsutism and irregular menses. She describes unpredictable and infrequent menses (five or six per year) since menarche at 11 years of age. Dark, coarse facial hair began to develop at 13 years of age. The symptoms worsened after she gained weight in college. The physical examination includes a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 29, blood pressure of 135/85 mm Hg, and moderate hirsutism without virilization. Laboratory tests reveal a total testosterone level of 65 ng per deciliter (2.3 nmol per liter) (assay reference range, 14 to 53 ng per deciliter [0.5 to 1.8 nmol per liter]), calculated free testosterone level of 15.3 pg per milliliter (53.1 pmol per liter) (assay reference range, 0.6 to 6.8 pg per milliliter [2.1 to 23.6 pmol per liter]), and glycated hemoglobin level of 5.7% (normal value, ≤5.6%). How should this case be evaluated and managed?
Topics: Contraceptives, Oral, Combined; Female; Hirsutism; Humans; Polycystic Ovary Syndrome; Young Adult
PubMed: 27406348
DOI: 10.1056/NEJMcp1514916 -
The Medical Clinics of North America Mar 2023Polycystic ovarian syndrome (PCOS) is a complex, familial, polygenetic metabolic condition. The Rotterdam criteria are commonly used to diagnose PCOS. Lifestyle changes... (Review)
Review
Polycystic ovarian syndrome (PCOS) is a complex, familial, polygenetic metabolic condition. The Rotterdam criteria are commonly used to diagnose PCOS. Lifestyle changes are the first-line treatment of PCOS. Treatment options for menstrual irregularities and hirsutism are based on the clinical goals and preferences of the patient. Along with treating the symptoms of PCOS, it is essential to screen and treat the comorbid conditions commonly associated with PCOS, including type 2 diabetes mellitus, obesity, nonalcoholic fatty liver disease, hyperlipidemia, obstructive sleep apnea, anxiety, depression, infertility, and vitamin D deficiency.
Topics: Female; Humans; Polycystic Ovary Syndrome; Hyperandrogenism; Diabetes Mellitus, Type 2; Hirsutism; Obesity
PubMed: 36759093
DOI: 10.1016/j.mcna.2022.10.004