Polycystic Ovary Syndrome: Challenges and Treatment Options

This theoretical thesis described the pathophysiological characteristics and treatment options for polycystic ovary syndrome (PCOS), the most common endocrine and metabolic disorder in women of reproductive age. PCOS was considered a multigenetic disorder with significant environmental influences, involving disruptions in the hypothalamus-pituitary-ovary axis, insulin resistance, obesity, and adrenal dysfunction. Key reproductive features included biochemical and clinical hyperandrogenism, (oligo)anovulation, and polycystic ovarian morphology. Women with PCOS had increased risks of glucose intolerance, type 2 diabetes, dyslipidemia, hypertension, and cardiovascular diseases, leading to reduced health-related quality of life and higher prevalence of depression, anxiety, psychosexual dysfunction, and eating disorders. Optimal treatment aimed to combine non-pharmacological measures, such as a hypocaloric diet and physical activity, with pharmacological treatments. Combined oral contraceptives were the first-line treatment for hyperandrogenism in non-pregnancy planning patients, with antiandrogens as a second line. Medroxyprogesterone acetate, levonorgestrel-releasing intrauterine systems, and combined oral contraceptives effectively regulated menstrual cycles, protecting against endometrial hyperplasia and cancer. Metformin was commonly used for metabolic irregularities, while clomiphene citrate was the first line for inducing ovulation in anovulatory PCOS patients.