POLYCYSTIC OVARIAN SYNDROME UNVEILED: NAVIGATING THE COMPLEXITIES AND IMPACTS ON WOMEN’S REPRODUCTIVE HEALTH

Main Article Content

Muhammad Ibtisam Elahi
Akif Saeed
Maryam Bakhat
Laiba Zahid
Ayesha Mansoor
Munaza Sabir
Muhammad Mudassar
Amna Bashir
Ayesha Bintay Farooq
Muhammad Akram
Aiman Aziz
Momina Iftikhar

Keywords

Polycystic ovarian syndrome, Insulin resistance, Hirsutism, and Hyperandrogenism

Abstract

PCOS, also known as polycystic ovarian syndrome, disturbs 6% to 15% of females of reproductive age. Many clinicians find it difficult to identify this widespread condition due to the lack of clear diagnostic criteria. Additionally, a patient may present to any number of clinicians due to the disorder's numerous presentations, including internists, family practitioners, nurse practitioners, pediatricians, gynecologists, endocrinologists, or dermatologists. Moreover, a patient's most troubling PCOS symptom may vary over time from hirsutism as an adolescent to sterility as a young mature necessitating visits to multiple doctors along the way. Therefore, it is critical that healthcare providers comprehend not just the specialty-specific management concerns but also the additional health risks associated with these women. Insulin resistance has been found to play a significant role in the pathophysiology of PCOS, highlighting the long-term risks associated with diabetes mellitus and the resulting elevated risk of coronary artery disease. Inconsistent menstruation and hirsutism are no longer considered harmless annoyances. The diagnosis/differential diagnosis and treatment options, the two most perplexing aspects of polycystic ovary syndrome for the practicing provider, will be the main topics of this study. The significance of insulin resistance (IR) and the potential treatment benefit of insulin sensitizers are particularly emphasized. Additionally, the advantage and critical nature of lifestyle changes for these women's long-term health are highlighted. It is believed that more clarity in this area will enable more women to receive the appropriate diagnosis and treatment for their presenting symptoms (hirsutism, irregular menses, etc.) as well as to receive education and care for the long-term health risks of IR.

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References

1. Yesiladali M, Yazici MGK, Attar E, Kelestimur F. Differentiating polycystic ovary syndrome from adrenal disorders. Diagnostics. 2022;12(9):2045.
2. Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertility and sterility. 2016;106(1):6-15.
3. Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology. 2018;14(5):270-84.
4. Aversa A, La Vignera S, Rago R, Gambineri A, Nappi RE, Calogero AE, et al. Fundamental concepts and novel aspects of polycystic ovarian syndrome: expert consensus resolutions. Frontiers in endocrinology. 2020;11:516.
5. Ortiz-Flores AE, Luque-Ramírez M, Escobar-Morreale HF. Polycystic ovary syndrome in adult women. Medicina Clínica (English Edition). 2019;152(11):450-7.
6. Sukhapure M. Androgens and the female brain: The relationship between testosterone levels, depression, anxiety, cognitive function, and emotion processing in females with polycystic ovarian syndrome. 2019.
7. Hernández-Peñalver AI, Sánchez-Ferrer ML, Mendiola J, Adoamnei E, Prieto-Sánchez MT, Corbalán-Biyang S, et al. Assessment of anogenital distance as a diagnostic tool in polycystic ovary syndrome. Reproductive BioMedicine Online. 2018;37(6):741-9.
8. Doycheva I, Ehrmann DA. Nonalcoholic fatty liver disease and obstructive sleep apnea in women with polycystic ovary syndrome. Fertility and Sterility. 2022;117(5):897-911.
9. Islam H, Masud J, Islam YN, Haque FKM. An update on polycystic ovary syndrome: A review of the current state of knowledge in diagnosis, genetic etiology, and emerging treatment options. Women's Health. 2022;18:17455057221117966.
10. Gorsic LK. Characterization of Rare Genetic Variation in Polycystic Ovary Syndrome. 2018.
11. Sengupta P, Dutta S, Liew FF, Dhawan V, Das B, Mottola F, et al. Environmental and Genetic Traffic in the Journey from Sperm to Offspring. Biomolecules. 2023;13(12):1759.
12. Soyman Z. Comparison of serum antimullerian hormone levels among four different phenotypes of polycystic ovary syndrome. 2021.
13. O'Reilly MW, Taylor AE, Crabtree NJ, Hughes BA, Capper F, Crowley RK, et al. Hyperandrogenemia predicts metabolic phenotype in polycystic ovary syndrome: the utility of serum androstenedione. The journal of clinical endocrinology & metabolism. 2014;99(3):1027-36.
14. Cutillas-Tolín A, Arense-Gonzalo JJ, Mendiola J, Adoamnei E, Navarro-Lafuente F, Sánchez-Ferrer ML, et al. Are dietary indices associated with polycystic ovary syndrome and its phenotypes? A preliminary study. Nutrients. 2021;13(2):313.
15. Ozegowska K, Korman M, Szmyt A, Pawelczyk LJIJoER, Health P. Heterogeneity of endocrinologic and metabolic parameters in reproductive age polycystic ovary syndrome (PCOS) women concerning the severity of hyperandrogenemia—a new insight on syndrome pathogenesis. 2020;17(24):9291.
16. Wang J, Wu D, Guo H, Li M. Hyperandrogenemia and insulin resistance: The chief culprit of polycystic ovary syndrome. Life sciences. 2019;236:116940.
17. Sanchez-Garrido MA, Tena-Sempere M. Metabolic dysfunction in polycystic ovary syndrome: Pathogenic role of androgen excess and potential therapeutic strategies. Molecular metabolism. 2020;35:100937.
18. Wang K, Li Y, Chen Y. Androgen excess: a hallmark of polycystic ovary syndrome. Frontiers in Endocrinology. 2023;14:1273542.
19. Rosenfield RL, Ehrmann DA. The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine reviews. 2016;37(5):467-520.
20. Stubbs SA, Webber LJ, Stark J, Rice S, Margara R, Lavery S, et al. Role of Insulin-like growth factors in initiation of follicle growth in normal and polycystic human ovaries. The Journal of Clinical Endocrinology & Metabolism. 2013;98(8):3298-305.
21. Dewailly D, Robin G, Peigne M, Decanter C, Pigny P, Catteau-Jonard S. Interactions between androgens, FSH, anti-Müllerian hormone and estradiol during folliculogenesis in the human normal and polycystic ovary. Human reproduction update. 2016;22(6):709-24.
22. Hassan A, Ahmed O, Ahmed M, Hamed H. The Relationship of Insulin Resistance and Polycystic Ovary Syndrome: Effects of Metformin Therapy and ovarian Drilling. Bulletin of Egyptian Society for Physiological Sciences. 2009;29(2):1-14.
23. Jeanes YM, Reeves S. Metabolic consequences of obesity and insulin resistance in polycystic ovary syndrome: diagnostic and methodological challenges. Nutrition research reviews. 2017;30(1):97-105.
24. Maqbool M, Gani I, Geer MI. Polycystic ovarian syndrome-a multifaceted disease: a review. Int J Pharm Sci Res. 2019;10(3):1072-79.
25. Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS. Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocrine reviews. 2015;36(5):487-525.
26. Rojewska P, Meczekalski B, Bala G, Luisi S, Podfigurna A. From diagnosis to treatment of androgen-secreting ovarian tumors: a practical approach. Gynecological Endocrinology. 2022;38(7):537-42.
27. Krishna D. Polycystic ovary syndrome. Kamini A Rao, Deepika Krishna Principles and Practice of Assisted Reproductive Technology Second edition Jaypee Brothers Medical Publishers Ltd. 2019:479-522.
28. Pignatelli D, Carvalho BL, Palmeiro A, Barros A, Guerreiro SG, Macut D. The complexities in genotyping of congenital adrenal hyperplasia: 21-hydroxylase deficiency. Frontiers in Endocrinology. 2019;10:432.
29. Omabe M, Nwobini Omabe K, Ademola Clement F, Maxwell Omabe G. Metabolic basis of polycystic ovarian syndrome; indications for biochemical screening. Endocrine, Metabolic & Immune Disorders-Drug Targets (Formerly Current Drug Targets-Immune, Endocrine & Metabolic Disorders). 2016;16(1):61-71.
30. Donma M, Donma O, Topçu B, Aydın M, Tülübaş F, Nalbantoğlu B, et al. A new insulin sensitivity index derived from fat mass index and quantitative insulin sensitivity check index. International Journal of Basic and Clinical Medicine. 2015;3(1):26-36.
31. Ortiz-Martínez M, González-González M, Martagón AJ, Hlavinka V, Willson RC, Rito-Palomares M. Recent developments in biomarkers for diagnosis and screening of type 2 diabetes mellitus. Current diabetes reports. 2022;22(3):95-115.
32. Suresh N. Dyslipidemia and Hypertension in Obese Patients with Correlation to Body Mass Index. 2009.
33. Deepa KP. A Comparative study on the Fasting and Post Prandial Lipid Levels as a Cardiovascular Risk Factor in Patients with Type 2 Diabetes Mellitus. 2017.
34. Kuwabara M, Chintaluru Y, Kanbay M, Niwa K, Hisatome I, Andres-Hernando A, et al. Fasting blood glucose is predictive of hypertension in a general Japanese population. Journal of hypertension. 2019;37(1):167-74.
35. Yang Y, Ouyang N, Ye Y, Hu Q, Du T, Di N, et al. The predictive value of total testosterone alone for clinical hyperandrogenism in polycystic ovary syndrome. Reproductive BioMedicine Online. 2020;41(4):734-42.
36. Imran HJ, Dhaher SA, Mansour AA. Testosterone or Dehydroepiandrosterone Sulfate as a Biomarker for Hirsutism in Women with Polycystic Ovary Syndrome. Biomedical and Pharmacology Journal. 2020;13(4):1815-23.
37. Edinoff AN, Silverblatt NS, Vervaeke HE, Horton CC, Girma E, Kaye AD, et al. Hyperprolactinemia, clinical considerations, and infertility in women on antipsychotic medications. Psychopharmacology bulletin. 2021;51(2):131.
38. Kim SI, Yoon JH, Park DC, Yang SH, Kim YI. What is the optimal prolactin cutoff for predicting the presence of a pituitary adenoma in patients with polycystic ovary syndrome? International Journal of Medical Sciences. 2023;20(4):463.
39. Oguz SH, Yildiz BO. An update on contraception in polycystic ovary syndrome. Endocrinology and Metabolism. 2021;36(2):296.
40. Peña AS, Witchel SF, Hoeger KM, Oberfield SE, Vogiatzi MG, Misso M, et al. Adolescent polycystic ovary syndrome according to the international evidence-based guideline. BMC medicine. 2020;18:1-16.
41. Witchel SF, Oberfield S, Rosenfield RL, Codner E, Bonny A, Ibáñez L, et al. The diagnosis of polycystic ovary syndrome during adolescence. Hormone research in paediatrics. 2015;83(6):376-89.
42. Xie J, Burstein F, Garad R, Teede HJ, Boyle JA, editors. Personalized mobile tool AskPCOS delivering evidence-based quality information about polycystic ovary syndrome2018: Thieme Medical Publishers.
43. Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Human reproduction update. 2016;22(6):687-708.
44. Naz S, Amerjee A. Management of subfertility in polycystic ovary syndrome. Polycystic Ovary Syndrome: Elsevier; 2024. p. 141-60.
45. Teal S, Edelman A. Contraception selection, effectiveness, and adverse effects: a review. Jama. 2021;326(24):2507-18.
46. Costello MF, Misso ML, Balen A, Boyle J, Devoto L, Garad RM, et al. Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: assessment and treatment of infertility. Human reproduction open. 2019;2019(1):hoy021.
47. Tian Z, Zhang Y-C, Wang Y, Chang X-H, Zhu H-L, Zhao Y. Effects of bariatric surgery on patients with obesity and polycystic ovary syndrome: a meta-analysis. Surgery for Obesity and Related Diseases. 2021;17(8):1399-408.
48. Zehravi M, Maqbool M, Ara I. Polycystic ovary syndrome and infertility: an update. International journal of adolescent medicine and health. 2022;34(2):1-9.
49. Mayer SB, Evans WS, Nestler JE. Polycystic ovary syndrome and insulin: our understanding in the past, present and future. Women’s Health. 2015;11(2):137-49.
50. Petersen KB, Pedersen NG, Pedersen AT, Lauritsen MP, la Cour Freiesleben N. Mono-ovulation in women with polycystic ovary syndrome: a clinical review on ovulation induction. Reproductive biomedicine online. 2016;32(6):563-83.
51. Rashid R, Mir SA, Kareem O, Ali T, Ara R, Malik A, et al. Polycystic ovarian syndrome-current pharmacotherapy and clinical implications. Taiwanese Journal of Obstetrics and Gynecology. 2022;61(1):40-50.
52. Elnashar AM. The role of metformin in ovulation induction: Current status. Middle East fertility society journal. 2011;16(3):175-81.
53. Banaszewska B, Pawelczyk L, Spaczynski RJRb. Current and future aspects of several adjunctive treatment strategies in polycystic ovary syndrome. 2019;19(4):309-15.
54. Wu Y, Tu M, Huang Y, Liu Y, Zhang D. Association of metformin with pregnancy outcomes in women with polycystic ovarian syndrome undergoing in vitro fertilization: a systematic review and meta-analysis. JAMA network open. 2020;3(8):e2011995-e.
55. Taylor-Giorlando M, Pal L. Surgical Management of Polycystic Ovary Syndrome: A Contemporary Viewpoint on Place of Ovarian Surgery in PCOS Management. Polycystic Ovary Syndrome: Current and Emerging Concepts: Springer; 2022. p. 363-74.
56. Cohen J. Laparoscopic surgical treatment of infertility related to PCOS revisited. Free ebooks==> www Ebook777 com. 2007.
57. Wang R, Li W, Bordewijk EM, Legro RS, Zhang H, Wu X, et al. First-line ovulation induction for polycystic ovary syndrome: an individual participant data meta-analysis. Human reproduction update. 2019;25(6):717-32.

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