ECE2018 Symposia Borderline testosterone and metabolic outcomes among sexes: clinical relevance (3 abstracts)
Serbia.
Although there are many phenotypes of polycystic ovarian syndrome (PCOS), we are mainly talking about three phenotypes: metabolic, hyperandrogenic and reproductive phenotype. Obesity and insulin resistance are the major determinants of the metabolic heterogeneity of patients with PCOS. Certain degree of hepatic insulin resistance exists in PCOS irrespective of obesity. In non-obese PCOS preserved insulin sensitivity in peripheral tissues exists. The presence of obesity is of great importance for the treatment of the syndrome. The most important approach should be made to prevent obesity and abdominal adiposity in non-obese women with PCOS. Lifestyle modification, diet and regular physical activity, and anti-obesity drugs, bariatric surgery may be useful in some obese PCOS. It is still dilemma should metabolic complications influence the choice of treatment for PCOS: insulin sensitizer drugs or COCs. Hyperandrogenic phenotype is the most common form of PCOS. Lifestyle changes in the presence of obesity are first line treatment. Pharmacological agents consist of COCs and antiandrogens or combination. In reproductive phenotype, infrequent or absent ovulation is the predominant problem in PCOS women. The main therapeutic issues for women with PCOS and reproductive dysfunction are treatment of infertility or menstrual regulation in PCOS women who do not desire pregnancy. Weight reduction alone may result in spontaneous ovulation in overweight/obese PCOS women. Induction of ovulation can be achieved either by raising endogenous levels of FSH or by giving exogenous FSH by daily injection. The estrogen receptor antagonist, clomiphene citrate, is first choice treatment for induction of ovulation in PCOS, while other antiestrogens are aromatase inhibitors. Metformin has been reported to improve ovulation rates in PCOS women when given alone or together with clomiphene citrate. A low-dose COC may be the most convenient form of treatment for all menstrual irregularities, although cyclical progestogen is an also reasonable alternative.