POLYCYSTIC OVARY SYNDROME: A COMPREHENSIVE OVERVIEW AND CURRENT TREATMENT APPROACHES

Аннотация

Polycystic ovary syndrome (PCOS) is a multifactorial, heterogeneous endocrine disorder characterized by menstrual cycle abnormalities, chronic anovulation, hyperandrogenism, and morphological changes in the ovaries. Despite 75 years of research and various treatment modalities developed, PCOS remains a leading cause of endocrine infertility, highlighting the continued need for advancement and optimization of therapeutic methods. Keywords: Polycystic ovary syndrome, menstrual irregularities, chronic anovulation, hyperandrogenism, insulin resistance, body mass index, quality of life, infertility, diagnosis, treatment. СИНДРОМ ПОЛИКИСТОЗНЫХ ЯИЧНИКОВ: ВСЕСТОРОННИЙ ОБЗОР И СОВРЕМЕННЫЕ ПОДХОДЫ К ЛЕЧЕНИЮ Аннотация. Синдром поликистозных яичников (СПКЯ) — многофакторное, гетерогенное эндокринное расстройство, характеризующееся нарушениями менструального цикла, хронической ановуляцией, гиперандрогенией и морфологическими изменениями в яичниках. Несмотря на 75 лет исследований и различные разработанные методы лечения, СПКЯ остается ведущей причиной эндокринного бесплодия, что подчеркивает постоянную необходимость в совершенствовании и оптимизации терапевтических методов. Ключевые слова: Синдром поликистозных яичников, нарушения менструального цикла, хроническая ановуляция, гиперандрогения, инсулинорезистентность, индекс массы тела, качество жизни, бесплодие, диагностика, лечение. Etiology and Pathogenesis The exact etiology of PCOS remains unclear; however, several contributing factors have been identified. These include complications during pregnancy or childbirth, infections (particularly during puberty), head injuries, chronic stress, recurring inflammatory diseases of reproductive organs, genetically determined enzymatic defects in ovarian steroidogenesis, and hereditary predisposition. 937 ResearchBib IF - 11.01, ISSN: 3030-3753, Volume 2 Issue 4 The pathogenesis primarily involves chronic anovulation driven by hyperandrogenism and increased peripheral conversion of androgens to estrogens, particularly in adipose tissue and the liver. Elevated estrogen disrupts the cyclic nature of pituitary gonadotropins, further promoting anovulation. Increased luteinizing hormone (LH) levels stimulate ovarian androgen production, while relatively low follicle-stimulating hormone (FSH) impairs follicle development. Additionally, insulin resistance significantly contributes to hyperandrogenism by enhancing androgen synthesis in ovarian theca cells and decreasing hepatic synthesis of sex hormone-binding globulin (SHBG), thereby increasing free testosterone levels. Diagnostic Criteria PCOS diagnosis follows the Rotterdam criteria, requiring at least two of three indicators: 1. Menstrual dysfunction, including oligomenorrhea or amenorrhea, indicative of anovulation. 2. Clinical and/or biochemical signs of hyperandrogenism such as elevated testosterone, reduced SHBG, and symptoms like hirsutism, acne, and alopecia. 3. Polycystic ovarian morphology, defined via ultrasound as the presence of at least 8–12 follicles of 2–10 mm diameter or ovarian volume exceeding 10 cm³. Clinical and Laboratory Evaluations The diagnostic evaluation includes detailed medical history, physical examination, ultrasound imaging of ovaries, and hormonal assessments (LH, FSH, testosterone, estradiol, DHEA-S, 17-hydroxyprogesterone, prolactin). Additional metabolic screenings, such as glucose tolerance tests, lipid profile analyses, and body mass index (BMI) calculations, are critical due to prevalent insulin resistance in 35–60% of PCOS patients. Treatment Approaches Current treatment strategies primarily aim to correct hormonal imbalances, restore ovulation, and manage clinical manifestations such as hirsutism and acne. The treatment approach varies according to metabolic status and reproductive goals:  PCOS with metabolic disturbances: Management initially includes lifestyle modifications (diet and exercise), insulin sensitizers (Metformin), and weight-reduction medications (Orlistat, Sibutramine).  PCOS without metabolic disturbances (not planning pregnancy): Common treatments include combined oral contraceptives (COCs) to regulate menstrual cycles and reduce androgen levels. Antiandrogens like Flutamide and Spironolactone are effective for managing symptoms such as hirsutism and acne.  PCOS without metabolic disturbances (planning pregnancy): Ovulation induction using Clomiphene citrate or gonadotropins is standard practice. 938 ResearchBib IF - 11.01, ISSN: 3030-3753, Volume 2 Issue 4 Progestins like Dydrogesterone or micronized progesterone are employed to correct endometrial hyperplasia. Surgical interventions, such as laparoscopic ovarian drilling or laser vaporization, are reserved for cases refractory to medical therapy but may lead to decreased ovarian reserve and ongoing infertility, necessitating assisted reproductive technologies (ART). Effectiveness and Outcomes Clinical outcomes of PCOS treatment are assessed after at least six months, eva