Modern aspects of management of patients with polycystic ovary syndrome




polycystic ovary syndrome, pathogenesis, phenotypes, diagnosis, treatment



The review article provides concepts of etiology, pathogenesis, and management of polycystic ovary syndrome (PCOS) in accordance with current international guideline and modern literature. The problem`s relevance is due not only to the prevalence of the syndrome among women of reproductive age – 8–13 %, 80 % – in the structure of anovulatory infertility.

Тhe etiology of the syndrome remains controversial, and PCOS clinical manifestations are among the most common in the structure of reproductive health disorders, which consequently leads to impaired functioning of almost all organs and systems of the body. Therefore, the syndrome is considered as a multisystem problem; it implies comprehensive approach to the correction of this condition by gynecologists, fertility specialists, endocrinologists, cardiologists, dermatologists and family doctors. Rotterdam criteria remain relevant in the international guideline (2018) for PCOS diagnosis.

For the sake of completeness, the classification of PCOS by phenotype remains relevant, which can help to assess the level of risk and the profile of possible concomitant disorders and to develop a rational, individualized plan for examination and treatment of the patient. The optimal diagnostic algorithm for PCOS at stage 1 presumes determining free testosterone index (total testosterone, sex hormone-binding globulin, free testosterone index). At stage 2, thyroid pathology should be excluded. This includes the following tests and examinations: thyroid-stimulating hormone, thyroidglobulin antibodies, Peroxidasa antibodies, ultrasound examination, hyperprolactinemia (prolactinoma), congenital suprarenal dysfunction (21-hydroxylase deficiency), Itsenko–Cushing’s syndrome, acromegaly, virilizing tumors. At stage 3, glycemic status is detected.

The management should be multidisciplinary, aimed at the correction of lifestyle, psycho-emotional disorders, and diet. Pharmacological therapy depends on the kind of metabolic and hormonal disorders.

Timely diagnosis, prevention, early start of PCOS therapy can contribute to the preservation of fertile potential, prevention of hyperplastic and neoplastic endometrial processes, late complications of this syndrome.



Doubossarskaya, Z. M. (2017) Obsuzhdenie novogo podkhoda k menedzhmentu sindroma polikistoznykh yaichnikov [Discussion of new approach to the management of polycystic ovary syndrome]. Zdorov'e zhenshchiny, (6), 45-48. [in Russian].

Zhuk S. I., & Gordiychuk, A B. (2018). SPKYa: Fenotipy, vistseral'noe ozhirenie i personalizirovannyi podkhod v naznachenii KOK [PCOS: phenotypes, visceral obesity and a personalized approach in the prescription of COC]. Reproductive Endocrinology, (2), 34-41. [in Russian].

Kaminskyi, V. V., Tatarchuk, T. F., & Dubossarska, Y. O. (2016). Natsionalnyi konsensus shchodo vedennia patsiientok iz hiperandroheniieiu [National consensus on the management of patients with hyperandrogenism]. Reproductive Endocrinology, (4), 19-31. [in Ukrainian].

Kalugina, L. V., & Yusko, T. I. (2018). Mio-inozitol: terapevticheskie vozmozhnosti i pregravidarnaya podgotovka pri sindrome polikistoznykh yaichnikov. Obzor literatury [Myo-inositol: therapeutic possibilities and pregravid preparation in women with pcos. Literature review]. Reproductive Endocrinology, (4), 40-45. [in Russian].

Semenyna, G. B. (2016). Endokrynni ta obminno-metabolichni porushennia v zhinok iz syndromom polikistoznykh yaiechnykiv i novi mozhlyvosti yikhnoi korektsii [Endocrine and metabolic disorders in women with polycystic ovary syndrome and new possibilities of their correction]. Reproductive Endocrinology, (6), 69-76. [in Ukrainian].

Semeniuk, L. M., Yuzvenko, T. Yu., & Larina, O. V. (2018). Osoblyvosti vuhlevodnoho obminu u zhinok rannoho reproduktyvnoho viku iz skleropolikistozom yaiechnykiv [Features of carbohydrate metabolism in women of early reproductive age with polycystic ovary syndrome]. International Journal of Endocrinology, 14(3), 229-234. [in Ukrainian].

Tatarchuk, T. F., & Kaluhina, L. V. (2018). Perspektyvy vykorystannia inozytoliv u korektsii insulinorezystentnosti u zhinok iz syndromom polikistoznykh yaiechnykiv [Prospects for the use of inositols in the correction of insulin resistance in women with polycystic ovary syndrome]. Zdorovia Ukrainy, (1. Hinekolohiia, Akusherstvo, Reproduktolohiia), 5-6. [in Ukrainian].

Al Khalifah, R. A., Florez, I. D., Dennis, B., Thabane, L., & Bassilious, E. (2016). Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis. Pediatrics, 137(5), Article e20154089.

American Diabetes Association. (2017). Standards of Medical Care in Diabetes-2017: Summary of Revisions. Diabetes care, 40(Suppl. 1), S4-S5.

Balen, A. H., Morley, L. C., Misso, M., Franks, S., Legro, R. S., Wijeyaratne, C. N., Stener-Victorin, E., Fauser, B. C., Norman, R. J., & Teede, H. (2016). 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, 22(6), 687-708.

Baskind, N. E., & Balen, A. H. (2016). Hypothalamic-pituitary, ovarian and adrenal contributions to polycystic ovary syndrome. Best Practice & Research Clinical Obstetrics & Gynaecology, 37, 80-97.

Bonnet, F., & Scheen, A. (2017). Understanding and overcoming metformin gastrointestinal intolerance. Diabetes, Obesity and Metabolism, 19(4), 473-481.

Boyle, J., Hollands, G., Beck, S., Hampel, G., Wapau, H., Arnot, M., Browne, L., Teede, H. J., & Moran, L. J. (2017). Process evaluation of a pilot evidence-based Polycystic Ovary Syndrome clinic in the Torres Strait. The Australian Journal of Rural Health, 25(3), 175-181.

Bozdag, G., Mumusoglu, S., Zengin, D., Karabulut, E., & Yildiz, B. O. (2016). The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction, 31(12), 2841-2855.

Brakta, S., Lizneva, D., Mykhalchenko, K., Imam, A., Walker, W., Diamond, M. P., & Azziz, R. (2017). Perspectives on Polycystic Ovary Syndrome: Is Polycystic Ovary Syndrome Research Underfunded? The Journal of Clinical Endocrinology & Metabolism, 102(12), 4421-4427.

Brennan, L., Teede, H., Skouteris, H., Linardon, J., Hill, B., & Moran, L. (2017). Lifestyle and Behavioral Management of Polycystic Ovary Syndrome. Journal of Women's Health, 26(8), 836-848.

Carmina, E., Campagna, A. M., Fruzzetti, F., & Lobo, R. A. (2016). AMH measurement versus ovarian ultrasound in the diagnosis of polycystic ovary syndrome in different phenotypes. Endocrine Practice, 22(3), 287-293.

Cassar, S., Misso, M. L., Hopkins, W. G., Shaw, C. S., Teede, H. J., & Stepto, N. K. (2016). Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Human Reproduction, 31(11), 2619-2631.

Cesta, C. E., Månsson, M., Palm, C., Lichtenstein, P., Iliadou, A. N., & Landén, M. (2016). Polycystic ovary syndrome and psychiatric disorders: Co-morbidity and heritability in a nationwide Swedish cohort. Psychoneuroendocrinology, 73, 196-203.

Charalampakis, V., Tahrani, A. A., Helmy, A., Gupta, J. K., & Singhal, R. (2016). Polycystic ovary syndrome and endometrial hyperplasia: an overview of the role of bariatric surgery in female fertility. European Journal of Obstetrics & Gynecology and Reproductive Biology, 207, 220-226.

Cooney, L. G., Lee, I., Sammel, M. D., & Dokras, A. (2017). High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction, 32(5), 1075-1091.

Sexual and reproductive health. (Ed.). (2015). Medical eligibility criteria for contraceptive use (5th ed.). World Health Organization.

Dokras, A., Stener-Victorin, E., Yildiz, B. O., Li, R., Ottey, S., Shah, D., Epperson, N., & Teede, H. (2018). Androgen Excess- Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertility and Sterility, 109(5), 888-899.

(2012, March 12). Evidence-Based Methodology Workshop on Polycystic Ovary Syndrome (PCOS). NICHD.

Harris, H. R., & Terry, K. L. (2016). Polycystic ovary syndrome and risk of endometrial, ovarian, and breast cancer: a systematic review. Fertility Research and Practice, 2, Article 14.

Heida, K. Y., Bots, M. L., de Groot, C. J., van Dunné, F. M., Hammoud, N. M., Hoek, A., Laven, J. S., Maas, A. H., Roeters van Lennep, J. E., Velthuis, B. K., & Franx, A. (2016). Cardiovascular risk management after reproductive and pregnancy-related disorders: A Dutch multidisciplinary evidence-based guideline. European Journal of Preventive Cardiology, 23(17), 1863-1879.

Ibrahim, M. H., Tawfic, M., Hassan, M. M., & Sedky, O. H. (2017). Letrozole versus laparoscopic ovarian drilling in infertile women with PCOS resistant to clomiphene citrate. Middle East Fertility Society Journal, 22(4), 251-254.

Centre for Research Excellence in Polycystic Ovary Syndrome (CREPCOS), European Society of Human Reproduction and Embryology (ESHRE), & American Society of Reproductive Medicine (ASRM). (2018). International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018. Monash University.

Kakoly, N. S., Khomami, M. B., Joham, A. E., Cooray, S. D., Misso, M. L., Norman, R. J., Harrison, C. L., Ranasinha, S., Teede, H. J., & Moran, L. J. (2018). Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression. Human Reproduction Update, 24(4), 455-467.

Kim, J. Y., Tfayli, H., Michaliszyn, S. F., Lee, S., Nasr, A., & Arslanian, S. (2017). Anti-Müllerian Hormone in Obese Adolescent Girls With Polycystic Ovary Syndrome. Journal of Adolescent Health, 60(3), 333-339.

Köninger, A., Koch, L., Edimiris, P., Enekwe, A., Nagarajah, J., Kasimir-Bauer, S., Kimmig, R., Strowitzki, T., & Schmidt, B. (2014). Anti-Mullerian Hormone: an indicator for the severity of polycystic ovarian syndrome. Archives of Gynecology and Obstetrics, 290(5), 1023-1030.

Lang, A. Y., Boyle, J. A., Fitzgerald, G. L., Teede, H., Mazza, D., Moran, L. J., & Harrison, C. (2018). Optimizing preconception health in women of reproductive age. Minerva Ginecologica, 70(1), 99-119.

Larsson, I., Hulthén, L., Landén, M., Pålsson, E., Janson, P., & Stener-Victorin, E. (2016). Dietary intake, resting energy expenditure, and eating behavior in women with and without polycystic ovary syndrome. Clinical Nutrition, 35(1), 213-218.

Li, J., Eriksson, M., Czene, K., Hall, P., & Rodriguez-Wallberg, K. A. (2016). Common diseases as determinants of menopausal age. Human Reproduction, 31(12), 2856-2864.

Lizneva, D., Gavrilova-Jordan, L., Walker, W., & Azziz, R. (2016). Androgen excess: Investigations and management. Best practice & research. Best Practice & Research Clinical Obstetrics & Gynaecology, 37, 98-118.

Mead, E., Atkinson, G., Richter, B., Metzendorf, M. I., Baur, L., Finer, N., Corpeleijn, E., O'Malley, C., & Ells, L. J. (2016). Drug interventions for the treatment of obesity in children and adolescents. Cochrane Database of Systematic Reviews, 11(11), Article CD012436.

Mehrabian, F., Ghasemi-Tehrani, H., Mohamadkhani, M., Moeinoddini, M., & Karimzadeh, P. (2016). Comparison of the effects of metformin, flutamide plus oral contraceptives, and simvastatin on the metabolic consequences of polycystic ovary syndrome. Journal of Research in Medical Sciences, 21, Article 7.

Merz, C. N., Shaw, L. J., Azziz, R., Stanczyk, F. Z., Sopko, G., Braunstein, G. D., Kelsey, S. F., Kip, K. E., Cooper-DeHoff, R. M., Johnson, B. D., Vaccarino, V., Reis, S. E., Bittner, V., Hodgson, T. K., Rogers, W., & Pepine, C. J. (2016). Cardiovascular Disease and 10-Year Mortality in Postmenopausal Women with Clinical Features of Polycystic Ovary Syndrome. Journal of Women's Health, 25(9), 875-881.

Morley, L. C., Tang, T., Yasmin, E., Norman, R. J., & Balen, A. H. (2017). Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database of Systematic Reviews, 11(11), Article CD003053.

National Institute for Health and Care. (2017, May 23). Eating Disorders: Recognition and Treatment. NICE.

Ollila, M. M., West, S., Keinänen-Kiukaanniemi, S., Jokelainen, J., Auvinen, J., Puukka, K., Ruokonen, A., Järvelin, M. R., Tapanainen, J. S., Franks, S., Piltonen, T. T., & Morin-Papunen, L. C. (2017). Overweight and obese but not normal weight women with PCOS are at increased risk of Type 2 diabetes mellitus-a prospective, population-based cohort study. Human Reproduction, 32(2), 423-431.

Ollila, M. M., Piltonen, T., Puukka, K., Ruokonen, A., Järvelin, M. R., Tapanainen, J. S., Franks, S., & Morin-Papunen, L. (2016). Weight Gain and Dyslipidemia in Early Adulthood Associate With Polycystic Ovary Syndrome: Prospective Cohort Study. The Journal of Clinical Endocrinology & Metabolism, 101(2), 739-747.

Peña, A. S., Doherty, D. A., Atkinson, H. C., Hickey, M., Norman, R. J., & Hart, R. (2018). The majority of irregular menstrual cycles in adolescence are ovulatory: results of a prospective study. Archives of Disease in Childhood, 103(3), 235-239.

Pinola, P., Piltonen, T. T., Puurunen, J., Vanky, E., Sundström-Poromaa, I., Stener-Victorin, E., Ruokonen, A., Puukka, K., Tapanainen, J. S., & Morin-Papunen, L. C. (2015). Androgen Profile Through Life in Women With Polycystic Ovary Syndrome: A Nordic Multicenter Collaboration Study. The Journal of Clinical Endocrinology & Metabolism, 100(9), 3400-3407.

Pundir, J., Psaroudakis, D., Savnur, P., Bhide, P., Sabatini, L., Teede, H., Coomarasamy, A., & Thangaratinam, S. (2018). Inositol treatment of anovulation in women with polycystic ovary syndrome: a meta-analysis of randomised trials. BJOG, 125(3), 299-308.

Rubin, K. H., Glintborg, D., Nybo, M., Abrahamsen, B., & Andersen, M. (2017). Development and Risk Factors of Type 2 Diabetes in a Nationwide Population of Women With Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism, 102(10), 3848-3857.

Saini, S., Gibson-Helm, M., Cooney, L., Teede, H., & Dokras, A. (2016). Gaps in knowledge in diagnosis and management of polycystic ovary syndrome. Fertility and Sterility, 106(3), Article e100.

Skovlund, C. W., Mørch, L. S., Kessing, L. V., & Lidegaard, Ø. (2016). Association of Hormonal Contraception With Depression. JAMA Psychiatry, 73(11), 1154-1162.

Taghavi, S. A., Bazarganipour, F., Montazeri, A., Kazemnejad, A., Chaman, R., & Khosravi, A. (2015). Health-related quality of life in polycystic ovary syndrome patients: A systematic review. Iranian Journal of Reproductive Medicine, 13(8), 473-482.

Unfer, V., Nestler, J. E., Kamenov, Z. A., Prapas, N., & Facchinetti, F. (2016). Effects of Inositol(s) in Women with PCOS: A Systematic Review of Randomized Controlled Trials. International Journal of Endocrinology, 2016, Article 1849162.

Uysal, G., Sahin, Y., Unluhizarci, K., Ferahbas, A., Uludag, S. Z., Aygen, E., & Kelestimur, F. (2017). Is acne a sign of androgen excess disorder or not? European Journal of Obstetrics & Gynecology, and Reproductive Biology, 211, 21-25.

FSRH Clinical Effectiveness Unit. (2020, November 1). FSRH Clinical Guideline: Combined Hormonal Contraception (January 2019, Amended November 2020). FSRH.

Yetim, A., Yetim, Ç., Baş, F., Erol, O. B., Çığ, G., Uçar, A., & Darendeliler, F. (2016). Anti-Müllerian Hormone and Inhibin-A, but not Inhibin-B or Insulin-Like Peptide-3, may be Used as Surrogates in the Diagnosis of Polycystic Ovary Syndrome in Adolescents: Preliminary Results. Journal of Clinical Research in Pediatric Endocrinology, 8(3), 288-297.

How to Cite

Avramenko, N. V., Kabachenko, O. V., Barkovskyi, D. Y., & Sierykh К. V. (2020). Modern aspects of management of patients with polycystic ovary syndrome. Zaporozhye Medical Journal, 22(6).