Endocrine and Reproductive Effects of Polycystic Ovarian Syndrome

    December 2014 in “ Obstetrics and Gynecology Clinics of North America ”
    Laura C. Ecklund, Rebecca Usadi
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    TLDR Losing 5-10% body weight can improve PCOS symptoms, letrozole is better than clomiphene for fertility, and managing weight and blood sugar is important to reduce pregnancy complications.
    The 2015 document outlines the endocrine and reproductive effects of Polycystic Ovarian Syndrome (PCOS), affecting 5% to 15% of women, and its management strategies. It emphasizes the importance of weight loss for overweight and obese women with PCOS, as a 5% to 10% reduction in body weight can improve menstrual function and pregnancy rates. Clomiphene citrate has been the traditional first-line treatment for anovulatory infertility, but letrozole is now suggested as a more effective alternative, based on the PPCOS II trial. Metformin is no longer recommended as a primary ovulation induction agent. For those resistant to clomiphene, treatments like dexamethasone, gonadotropins, laparoscopic ovarian drilling, and IVF are considered, with the latter recommended as a third-line treatment. The document also notes increased risks of pregnancy complications in women with PCOS, advocating for pregestational weight loss and glycemic control to reduce these risks. Additionally, it covers the use of hormonal contraceptives and insulin sensitizers for managing hyperandrogenism and menstrual irregularities, and the increased risk of endometrial cancer associated with PCOS.
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