Singh, S., Pal, N., Shubham, S., Sarma, D. K., Verma, V., Marotta, F., & Kumar, M. (2023). Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. Journal of clinical medicine, 12(4). https://doi.org/10.3390/jcm12041454
Singh S, Pal N, Shubham S, Sarma DK, Verma V, Marotta F, Kumar M. Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. Journal of clinical medicine. 2023;12(4). doi:10.3390/jcm12041454
Singh, S., et al. "Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics." Journal of clinical medicine, vol. 12, no. 4, 2023.
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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.
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
The paper is a narrative review. It describes no search method or quality rating of the studies it cites, so the reader cannot tell how they were chosen. Much of the evidence it gives for fecal microbiota transplant, IL-22 therapy and miRNA therapy in PCOS comes from rodent or laboratory work. The authors call for randomized trials and more research on gut bacteria and PCOS. Statements such as inositol being a sensible treatment option are the authors' own proposals. The review itself runs no comparison of treatments.
RRM Context
Restorative reproductive medicine treats missing ovulation as a finding with a cause to find. The review's closing point, that treatments have been directed at symptoms, names the gap a cause-based workup addresses. The review says oral contraceptives lower androgens through feedback on luteinizing hormone. Couple-centered care looks at 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.
Recent diagnostic and pharmacologic developments have focused renewed attention on polycystic ovary syndrome. Clinical features of the syndrome include anovulation, hyperandrogenism and menstrual dysfunction, but several other abnormalities, including hyperinsulinemia, luteinizing hormone hypersecretion, elevated testosterone levels and acyclic estrogen production, have been documented. Accompanying obesity and lipid abnormalities compound the risk of developing diabetes mellitus or cardiovascular disease, and chronic anovulation increases the risk for endometrial cancer. A careful history and physical examination should guide diagnostic testing. Slowly progressive hyperandrogenic symptoms with anovulation of peripubertal onset often represent polycystic ovary syndrome. Treatment goals include symptom management and the identification and prevention of potential cardiovascular risks. Treatment should take into account the patient's desire for fertility. Advances in transvaginal ultrasonography and infertility treatments, including newer medications, have facilitated assisted reproduction in patients with polycystic ovary syndrome. Ongoing pharmacologic research focusing on the treatment of insulin resistance appears promising in reversing the longterm complications of the syndrome.
Farrell K et al., 2010·Fertil Steril·Free full text on PubMed Central
To summarize physiological and psychological characteristics that are common among women diagnosed with polycystic ovary syndrome (PCOS) and provide evidence suggesting that addressing psychological disturbances can reduce or alleviate physical symptoms of PCOS through behavioral pathways and physiological pathways. METHOD(S): Empirical studies and expert consensuses pertaining to physiological, psychological, and medical management aspects of PCOS were identified and presented in this review. Articles were identified by searching Pubmed, PsycInfo, Medline ISI, CINAHL, or a Web browser (i.e., Google) using numerous combinations of terms pertaining to physiological, psychological, and medical management aspects of PCOS. An article was chosen to be included in this review if it reported findings and/or provided information that related to and helped support the main purpose(s) of this review article. RESULT(S): Available literature on the physiological (i.e., hyperandrogenism, central obesity, inflammation, insulin resistance) and psychological (i.e., depression, anxiety, eating disorders) factors among women with PCOS provides evidence that these various aspects of PCOS are strongly interrelated. CONCLUSION(S): The existence of these relationships among physiological and psychological factors strongly suggests that medical management of PCOS would greatly benefit from inclusion of psychological and behavioral approaches.
Livadas S et al., 2022·World journal of diabetes·Free full text on PubMed Central
Polycystic ovary syndrome (PCOS) often coexists with a wide spectrum of dysglycemic conditions, ranging from impaired glucose tolerance to type 2 diabetes mellitus (T2D), which occur to a greater extent compared to healthy body mass index-matched women. This concurrence of disorders is mainly attributed to common pathogenetic pathways linking the two entities, such as insulin resistance. However, due to methodological flaws in the available studies and the multifaceted nature of the syndrome, there has been substantial controversy as to the exact association between T2D and PCOS which has not yet been elucidated. The aim of this review is to present the best available evidence regarding the epidemiology of dysglycemia in PCOS, the unique pathophysiological mechanisms underlying the progression of dysglycemia, the most appropriate methods for assessing glycemic status and the risk factors for T2D development in this population, as well as T2D risk after transition to menopause. Proposals for application of a holistic approach to enable optimal management of T2D risk in PCOS are also provided. Specifically, adoption of a healthy lifestyle with adherence to improved dietary patterns, such the Mediterranean diet, avoidance of consumption of endocrine-disrupting foods and beverages, regular exercise, and the effect of certain medications, such as metformin and glucagon-like peptide 1 receptor agonists, are discussed. Furthermore, the maintenance of a healthy weight is highlighted as a key factor in achievement of a significant reduction of T2D risk in women with PCOS.
Senthilkumar H et al., 2025·Journal of translational medicine·Free full text on PubMed Central
Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects reproductive-aged women worldwide, causing hormonal imbalances and ovarian dysfunction. PCOS affects metabolic health and increases the risk of obesity, insulin resistance, and cardiovascular disease, in addition to infertility. This review delves deeper into the connections of gut microbiota with PCOS pathophysiology, particularly into its impact on hormone metabolism, obesity, inflammation, and insulin resistance by way of short-chain fatty acids, lipopolysaccharides, and gut-brain axis. Studies also show that changes in the metabolic processes and immune responses are seen in changes in the gut microbiota in PCOS subjects, such as changes in the Bacteroidetes and Firmicutes groups. Some bacteria, like Escherichia and Shigella, have been associated with dysbiosis in patients with PCOS, leading to systemic inflammation and changed hormone levels, which further worsen the clinical symptoms. Therapeutic interventions targeting the gut microbiota comprise probiotics, prebiotics, and fecal microbiota transplantation; these have potential to alleviate the symptoms of PCOS. Other precision microbiome-based therapies include postbiotics, and CRISPR-Cas9 genome editing, which are relatively new avenues toward precision treatment. This complex interlink of gut microbiota and PCOS pathophysiology will open the avenues for possible treatments for hormonal imbalances and metabolic problems that characterize these complex disorders. The review here focuses on the requirement of further studies to be able to elucidate the specific pathways relating gut microbiota dysregulation to PCOS and, thus, improve microbiome-based therapies for better clinical outcomes in affected individuals.
PMID 36835989 36835989 DOI 10.3390/jcm12041454 10.3390/jcm12041454 Singh et al. 2023, Singh 2023
Cite this article
Singh, S., Pal, N., Shubham, S., Sarma, D. K., Verma, V., Marotta, F., & Kumar, M. (2023). Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. Journal of clinical medicine, 12(4). https://doi.org/10.3390/jcm12041454
Singh S, Pal N, Shubham S, Sarma DK, Verma V, Marotta F, Kumar M. Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. Journal of clinical medicine. 2023;12(4). doi:10.3390/jcm12041454
Singh, S., et al. "Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics." Journal of clinical medicine, vol. 12, no. 4, 2023.
Keywords
FMT, PCOS, gut dysbiosis, gut microbiome, hyperandrogenism, hyperinsulinemia, metabolic disorders, miRNA therapy, probiotics