Jelica Bjekić-Macut*, Tamara Vukašin, Zelija Velija-Ašimi, Azra Bureković, Marija Zdravković, Zoran Andrić, Marija Branković, Slobodanka Crevar-Marinović, Tatjana Madić, Olivera Stanojlović, Danijela V. Milutinović, Sarantis Livadas and George Mastorakos Pages 3812 - 3820 ( 9 )
Polycystic ovary syndrome (PCOS) is a frequent endocrine disease in women during the reproductive period. It is considered a complex metabolic disorder with long-term metabolic, as well as reproductive consequences. Main pathophysiological pathways are related to the increased androgen levels and insulin resistance. Nowadays, genetic origins of PCOS are acknowledged, with numerous genes involved in the pathogenesis of hyperandrogenemia, insulin resistance, inflammation, and disturbed folliculogenesis. Rotterdam diagnostic criteria are most widely accepted and four PCOS phenotypes have been recognized. Metabolic abnormalities are more common in phenotypes 1 and 2. Women with classic PCOS are more obese and typically have the central type of obesity, more prevalently displaying dyslipidemia, insulin resistance, and metabolic syndrome that could be associated with an increased risk of cardiovascular complications during life. Heterogeneity of phenotypes demands an individualized approach in the treatment of women with PCOS. Metabolic therapies involve a lifestyle intervention followed by the introduction of insulin sensitizers including metformin and inositols, glucagon-like peptide 1 receptor agonists (GLP-1 RA), as recently sodium-glucose cotransporter-2 (SGLT2) inhibitors. The addition of an insulin sensitizer to the standard infertility therapy such as clomiphene citrate improves ovulation and pregnancy rates. Our current review analyzes the contemporary knowledge of PCOS etiology and etiopathogenesis, its cardiometabolic risks and their outcomes, as well as therapeutic advances for women with PCOS.
Polycystic ovary syndrome, hyperandrogenism, insulin resistance, genetic abnormalities, metformin, GLP-1 RA, SGLT2 inhibitors.
Department of Endocrinology, CHC Bežanijska kosa, Faculty of Medicine, University of Belgrade, Belgrade, epartment of Endocrinology, CHC Bežanijska kosa, Belgrade, Sarajevo Medical School SSST University, Outpatient Clinic with Daily Hospital “Al Tawil”, Sarajevo, Sarajevo University Clinical Center, Faculty of Medicine, University of Sarajevo, Sarajevo, Department of Cardiology, CHC Bežanijska kosa, Faculty of Medicine, University of Belgrade, Belgrade, Department of Medical Oncology, CHC Bežanijska kosa, Belgrade, Department of Gastroenterology, CHC Bežanijska kosa, Faculty of Medicine, University of Belgrade, Belgrade, Department of Gastroenterology, CHC Bežanijska kosa, Faculty of Medicine, University of Belgrade, Belgrade, Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Institute of Medicinal Physiology, Faculty of Medicine, University of Belgrade, Belgrade, Department of Biochemistry, Institute for Biological Research "Siniša Stanković", University of Belgrade, Belgrade, Endocrine Unit, Metropolitan Hospital, Athens, Unit of Endocrine Diseases, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens