Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics

Samradhi Singh; Namrata Pal; Swasti Shubham; Devojit Kumar Sarma; Vinod Verma; Francesco Marotta; Manoj Kumar

doi:10.3390/jcm12041454

PMOS / PCOS Pathophysiology

Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics

Singh S, Pal N, Shubham S, Sarma DK, Verma V, Marotta F, Kumar M

Published February 11, 2023 Journal of clinical medicine, 12(4)

DOI 10.3390/jcm12041454 PMID 36835989 PMC PMC9964744

RRM Academy Synopsis

PCOS treatments so far target symptoms, a review finds

A 2023 review of PCOS, also called PMOS, finds that treatments so far have targeted symptoms, and no single fix exists. The authors cover causes, current drugs and early ideas.

Study at a glance, narrative review: PCOS treatments so far target symptoms, and no single fix exists. Source: Singh S et al., 2023, PMID 36835989.

Key Findings

The authors list pollutants, diet, genetics, obesity and gut dysbiosis as possible contributors to polycystic ovary syndrome (PCOS), now renamed polyendocrine metabolic ovarian syndrome (PMOS), and call its causes hard to identify.
The review calls oral contraceptives (suppressive medications) first-line management for irregular periods, hirsutism and acne, and covers insulin-lowering and ovulation-inducing drugs.
The review reports that studies found less diverse gut microbiota in women with PCOS than in controls, with fewer Lactobacilli and Bifidobacteria and more Escherichia and Shigella.
The authors report no clinical reports of fecal microbiota transplant for PCOS, only rodent studies. They state that no medication yet targets the miRNAs involved in PCOS.
The review reports that women with PCOS who lose excess weight through lifestyle changes experience regulated menstruation and improved reproductive outcomes.

Interpretation

This narrative review describes PCOS causes, current drugs and early-stage ideas, including fecal transplant, IL-22 therapy and miRNA therapy. The authors call for randomized trials and more research on gut bacteria in PCOS. The findings support larger, controlled studies of these approaches.

RRM Context

Restorative reproductive medicine treats missing ovulation as a finding with a cause to find. The review's closing point, that treatments target symptoms, names the gap a cause-based workup addresses. The review says birth control pills lower androgens by acting on luteinizing hormone. Couple-centered care examines both partners when fertility is the concern.

Our editorial summary of this paper, not the article's abstract.

Abstract

Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder, typically characterized by anovulation, infertility, obesity, insulin resistance, and polycystic ovaries. Lifestyle or diet, environmental pollutants, genetics, gut dysbiosis, neuroendocrine alterations, and obesity are among the risk factors that predispose females to PCOS. These factors might contribute to upsurging metabolic syndrome by causing hyperinsulinemia, oxidative stress, hyperandrogenism, impaired folliculogenesis, and irregular menstrual cycles. Dysbiosis of gut microbiota may play a pathogenic role in the development of PCOS. The restoration of gut microbiota by probiotics, prebiotics, or a fecal microbiota transplant (FMT) might serve as an innovative, efficient, and noninvasive way to prevent and mitigate PCOS. This review deliberates on the variety of risk factors potentially involved in the etiology, prevalence, and modulation of PCOS, in addition to plausible therapeutic interventions, including miRNA therapy and the eubiosis of gut microbiota, that may help treat and manage PCOS.

Read the guide

PMOS / PCOS: Causes, Diagnosis, and Treatment

PMOS / PCOS has four diagnostic phenotypes and distinct metabolic, reproductive, and mental health implications. How RRM-trained clinicians approach diagnosis and treatment differently.

20 min read

Topics

PMOS / PCOS › Pathophysiology › Insulin Resistance · Reproductive Endocrinology › Ovarian Hormones › Androgens · Therapeutics › Metabolic and Endocrine Agents › Insulin Sensitizing Agents

Samradhi Singh, Namrata Pal, Swasti Shubham, Devojit Kumar Sarma, Vinod Verma, Francesco Marotta, Manoj Kumar

S Singh, N Pal, S Shubham, D Sarma, V Verma, F Marotta, M Kumar

PMID 36835989 36835989 DOI 10.3390/jcm12041454 10.3390/jcm12041454 Singh et al. 2023, Singh 2023

Keywords

FMT, PCOS, gut dysbiosis, gut microbiome, hyperandrogenism, hyperinsulinemia, metabolic disorders, miRNA therapy, probiotics

Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics

PCOS treatments so far target symptoms, a review finds

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

PMOS / PCOS: Causes, Diagnosis, and Treatment

Topics

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Keywords