В настоящее время критерии диагностики синдрома поликистозных яичников (СПКЯ) рассматриваются с акцентом на стратификацию подтипов по метаболическим особенностям. В дальнейшем от выявленного подтипа пересматриваются варианты лечения в соответствии с целью ведения: облегчение симптомов гиперандрогении, регуляция менструаций и восстановление фертильности. Особенности диагностики СПКЯ, в том числе ультразвуковые, имеют значение для постановки диагноза. Считается, что в будущих исследованиях в центре внимания должны оказаться акценты, направленные на изучение последствий для здоровья женщин в постменопаузе с СПКЯ.
Currently, the diagnostic criteria for polycystic ovary syndrome (PCOS) are focused on the stratification of subtypes by metabolic features. Depending on the identified subtype, treatment options are revised following the management goal: improvement of the hyperandrogenism symptoms, menstruation regulation, and fertility recovery. The PCOS diagnostic features, including ultrasound pattern, are essential for the diagnosis. Future studies should focus on the health effects of postmenopausal women with PCOS.
1. Patel S. Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy. J Steroid Biochem Mol Biol. 2018;182:27-36. DOI:10.1016/j.jsbmb.2018.04.008
2. Teede HJ, Misso ML, Costello MF, et al. International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018;110(3):364-79.
3. Goodman NF, Cobin RH, Futterweit W, et al. American Association of Clinical Endocrinologists (AACE); American College of Endocrinology (ACE); Androgen Excess and PCOS Society. American Association of Clinical Endocrinologists, American College Of Endocrinology, And Androgen Excess and Pcos Society Disease State Clinical Review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome – part 2. Endocr Pract. 2015;21(12):1415-26.
4. Azziz R, Carmina E, Chen Z, et al. Polycysticovarysyndrome. Nat Rev Dis Primers. 2016;2:16057.
5. Carvalho MJ, Subtil S, Rodrigues A, et al. Controversial association between polycystic ovary syndrome and breast cancer. Eur J Obstet Gynecol Reprod Biol. 2019;243:125-32. DOI:10.1016/j.ejogrb.2019.10.011
6. Meczekalski B, Pérez-Roncero GR, López-Baena MT, et al. The polycystic ovary syndrome and gynecological cancer risk. Gynecol Endocrinol. 2020;36(4):289-93. DOI:10.1080/09513590.2020.1730794
7. Wen Y, Wu X, Peng H, et al. Breast cancer risk in patients with polycystic ovary syndrome: a Mendelian randomization analysis. Breast Cancer Res Treat. 2021;185(3):799-806. DOI:10.1007/s10549-020-05973-z
8. Spritzer PM, Barone CR, Oliveira FB. Hirsutism in Polycystic Ovary Syndrome: Pathophysiology and Management. Curr Pharm Des. 2016;22(36):5603-13.
9. Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol. 2018;132(2):321-36. DOI:10.1097/AOG.0000000000002698
10. Meier RK. Polycystic Ovary Syndrome. Nurs Clin North Am. 2018;53(3):407-20. DOI:10.1016/j.cnur.2018.04.008
11. Bednarska S, Siejka A. The pathogenesis and treatment of polycystic ovary syndrome: What's new? Adv Clin Exp Med. 2017;26(2):359-67. DOI:10.17219/acem/59380
12. Neven ACH, Laven J, Teede HJ, Boyle JA. A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines. Semin Reprod Med. 2018;36(1):5-12.
13. Escobar-Morreale HF. Polycystic ovary syndrome: definition, etiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270-84. DOI:10.1038/nrendo.2018.24
14. Zhang J, Bao Y, Zhou X, Zheng L. Polycystic ovary syndrome and mitochondrial dysfunction. Reprod Biol Endocrinol. 2019;17(1):67. DOI:10.1186/s12958-019-0509-4
15. Rothenberg SS, Beverley R, Barnard E, et al. Polycystic ovary syndrome in adolescents. Best Pract Res Clin Obstet Gynaecol. 2018;48:103-14. DOI:10.1016/j.bpobgyn.2017.08.008
16. DiVall S, Merjaneh L. Adolescent Polycystic Ovary Syndrome: An Update. Pediatr Ann. 2019;48(8):e304-10. DOI:10.3928/19382359-20190729-01
17. Bellver J, Rodríguez-Tabernero L, Robles A, et al. Group of interest in Reproductive Endocrinology (GIER) of the Spanish Fertility Society (SEF). Polycystic ovary syndrome throughout a woman's life. J Assist Reprod Genet. 2018;35(1):25-39. DOI:10.1007/s10815-017-1047-7
18. Rodriguez-Paris D, Remlinger-Molenda A, Kurzawa R, et al. Psychiatric disorders in women with polycystic ovary syndrome. Psychiatr Pol. 2019;53(4):955-66. DOI:10.12740/PP/OnlineFirst/93105
19. Ezeh U, Huang A, Landay M, Azziz R. Long-Term Response of Hirsutism and Other Hyperandrogenic Symptoms to Combination Therapy in Polycystic Ovary Syndrome. J Womens Health (Larchmt). 2018;27(7):892-902.
20. Lizneva D, Gavrilova-Jordan L, Walker W, Azziz R. Androgen excess: Investigations and management. Best Pract Res Clin Obstet Gynaecol. 2016;37:98-118.
21. Lause M, Kamboj A, Fernandez Faith E. Dermatologic manifestations of endocrine disorders. Transl Pediatr. 2017;6(4):300-12.
22. Melibary YT. Hidradenitis suppurativa in a patient with hyperandrogenism, insulin-resistance and acanthosis nigricans (HAIR-AN syndrome). Dermatol Reports. 2018;10(1):7546.
23. Keen MA, Shah IH, Sheikh G. Cutaneous Manifestations of Polycystic Ovary Syndrome: A Cross-Sectional Clinical Study. Indian Dermatol Online J. 2017;8(2):104-10.
24. Glueck CJ, Goldenberg N. Characteristics of obesity in polycystic ovary syndrome: Etiology, treatment, and genetics. Metabolism. 2019;92:108-20.
25. Pasquali R, Oriolo C. Obesity and Androgens in Women. Front Horm Res. 2019;53:120-34.
26. Zheng SH, Li XL. Visceral adiposity index as a predictor of clinical severity and therapeutic outcome of PCOS. Gynecol Endocrinol. 2016;32(3):177-83.
27. Rodgers R, Avery J, Moore V, et al. Complex diseases and co-morbidities: polycystic ovary syndrome and type 2 diabetes mellitus. Endocr Connect. 2019:EC-18-0502.R2. DOI:10.1530/EC-18-0502
28. Беленькая Л.В. Критерии ожирения в азиатской популяции. Обзор литературы. Acta Biomedica Scientifica. 2018;(3):99-102 [Belenkaya LV. Criteria of obesity for Asian population. Literature review. Acta Biomedica Scientifica. 2018;3(3):99-102 (in Russian)].
29. Osibogun O, Ogunmoroti O, Michos ED. Polycystic ovary syndrome and cardiometabolic risk: Opportunities for cardiovascular disease prevention. Trends Cardiovasc Med. 2020;30(7):399-404.
30. Papadakis G, Kandaraki E, Papalou O, et al. Is cardiovascular risk in women with PCOS a real risk? Current insights. Minerva Endocrinol. 2017;42(4):340-55.
31. Meun C, Gunning MN, Louwers YV, et al. The cardiovascular risk profile of middle-aged women with polycystic ovary syndrome. Clin Endocrinol (Oxford). 2020;92(2):150-8.
32. Delitala AP, Capobianco G, Delitala G, et al. Polycystic ovary syndrome, adipose tissue and metabolic syndrome. Arch Gynecol Obstet. 2017;296(3):405-19.
33. Mulder CL, Lassi ZS, Grieger JA, et al. Cardio-metabolic risk factors among young infertile women: a systematic review and meta-analysis. BJOG. 2020;127(8):930-9.
34. Damone AL, Joham AE, Loxton D, et al. Depression, anxiety and perceived stress in women with and without PCOS: a community-based study. Psychol Med. 2019;49(9):1510-20.
35. Cooney LG, Dokras A. Depression and Anxiety in Polycystic Ovary Syndrome: Etiology and Treatment. Curr Psychiatry Rep. 2017;19(11):83.
36. Rodriguez-Paris D, Remlinger-Molenda A, Kurzawa R, et al. Psychiatric disorders in women with polycystic ovary syndrome. Psychiatr Pol. 2019;53(4):955-66.
37. Brutocao C, Zaiem F, Alsawas M, et al. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine. 2018;62(2):318-25.
38. Gibson-Helm M, Teede H, Dunaif A, et al. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2017;102(2):604-12.
39. Dokras A, Saini S, Gibson-Helm M, et al. Gaps in knowledge among physicians regarding diagnostic criteria and management of polycystic ovary syndrome. Fertil Steril. 2017;107(6):1380-6.e1.
40. Balen AH, Morley LC, Misso M, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: An analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update. 2016;22(6):687-708.
41. Tosi F. Implications of androgen assay accuracy in the phenotyping of women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2016;101(2):610-8.
42. Прилепская В.Н., Абакарова П.Р., Яроцкая Е.Л. Современная контрацепция и качество жизни женщины. Доктор.Ру. 2017;3(132):37-42 [Prilepskaya VN, Abakarova PR, Yarotskaya YeL. Modern Contraception and Women’s Quality of Life. Doctor.Ru. 2017;3(132):37-42 (in Russian)].
43. Andersen M, Glintborg D. Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT? Eur J Endocrinol. 2018;179(3):D1-14. DOI:10.1530/EJE-18-0237
44. Anagnostis P, Tarlatzis BC, Kauffman RP. Polycystic ovarian syndrome (PCOS): Long-term metabolic consequences. Metabolism. 2018;86:33-43.
45. Nolan CJ, Prentki M. Insulin resistance and insulin hypersecretion in the metabolic syndrome and type 2 diabetes: Time for a conceptual framework shift. Diab Vasc Dis Res. 2019;16(2):118-27.
46. Pelanis R, Mellembakken JR, Sundström-Poromaa I, et al. The prevalence of Type 2 diabetes is not increased in normal-weight women with PCOS. Hum Reprod. 2017;32(11):2279-86.
47. Condorelli RA, Calogero AE, Di Mauro M, La Vignera S. PCOS and diabetes mellitus: from insulin resistance to altered beta pancreatic function, a link in evolution. Gynecol Endocrinol. 2017;33(9):665-7.
48. Jeanes YM, Reeves S. Metabolic consequences of obesity and insulin resistance in polycystic ovary syndrome: diagnostic and methodological challenges. Nutr Res Rev. 2017;30(1):97-105.
49. Osibogun O, Ogunmoroti O, Michos ED. Polycystic ovary syndrome and cardiometabolic risk: Opportunities for cardiovascular disease prevention. Trends Cardiovasc Med. 2020;30(7):399-404. DOI:10.1016/j.tcm.2019.08.010
50. Zhu RY, Wong YC, Yong EL. Sonographic evaluation of polycystic ovaries. Best Pract Res Clin Obstet Gynaecol. 2016;37:25-37.
51. Peña AS, Witchel SF, Hoeger KM, et al. Adolescent polycystic ovary syndrome according to the international evidence-based guideline. BMC Med. 2020;18(1):72. DOI:10.1186/s12916-020-01516-x
52. Meier RK. Polycystic Ovary Syndrome. Nurs Clin North Am. 2018;53(3):407-20. DOI:10.1016/j.cnur.2018.04.008
53. Cooney LG, Dokras A. Beyond fertility: polycystic ovary syndrome and long-term health. Fertil Steril. 2018;110(5):794-809. DOI:10.1016/j.fertnstert.2018.08.021
________________________________________________
1. Patel S. Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy. J Steroid Biochem Mol Biol. 2018;182:27-36. DOI:10.1016/j.jsbmb.2018.04.008
2. Teede HJ, Misso ML, Costello MF, et al. International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018;110(3):364-79.
3. Goodman NF, Cobin RH, Futterweit W, et al. American Association of Clinical Endocrinologists (AACE); American College of Endocrinology (ACE); Androgen Excess and PCOS Society. American Association of Clinical Endocrinologists, American College Of Endocrinology, And Androgen Excess and Pcos Society Disease State Clinical Review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome – part 2. Endocr Pract. 2015;21(12):1415-26.
4. Azziz R, Carmina E, Chen Z, et al. Polycysticovarysyndrome. Nat Rev Dis Primers. 2016;2:16057.
5. Carvalho MJ, Subtil S, Rodrigues A, et al. Controversial association between polycystic ovary syndrome and breast cancer. Eur J Obstet Gynecol Reprod Biol. 2019;243:125-32. DOI:10.1016/j.ejogrb.2019.10.011
6. Meczekalski B, Pérez-Roncero GR, López-Baena MT, et al. The polycystic ovary syndrome and gynecological cancer risk. Gynecol Endocrinol. 2020;36(4):289-93. DOI:10.1080/09513590.2020.1730794
7. Wen Y, Wu X, Peng H, et al. Breast cancer risk in patients with polycystic ovary syndrome: a Mendelian randomization analysis. Breast Cancer Res Treat. 2021;185(3):799-806. DOI:10.1007/s10549-020-05973-z
8. Spritzer PM, Barone CR, Oliveira FB. Hirsutism in Polycystic Ovary Syndrome: Pathophysiology and Management. Curr Pharm Des. 2016;22(36):5603-13.
9. Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol. 2018;132(2):321-36. DOI:10.1097/AOG.0000000000002698
10. Meier RK. Polycystic Ovary Syndrome. Nurs Clin North Am. 2018;53(3):407-20. DOI:10.1016/j.cnur.2018.04.008
11. Bednarska S, Siejka A. The pathogenesis and treatment of polycystic ovary syndrome: What's new? Adv Clin Exp Med. 2017;26(2):359-67. DOI:10.17219/acem/59380
12. Neven ACH, Laven J, Teede HJ, Boyle JA. A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines. Semin Reprod Med. 2018;36(1):5-12.
13. Escobar-Morreale HF. Polycystic ovary syndrome: definition, etiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270-84. DOI:10.1038/nrendo.2018.24
14. Zhang J, Bao Y, Zhou X, Zheng L. Polycystic ovary syndrome and mitochondrial dysfunction. Reprod Biol Endocrinol. 2019;17(1):67. DOI:10.1186/s12958-019-0509-4
15. Rothenberg SS, Beverley R, Barnard E, et al. Polycystic ovary syndrome in adolescents. Best Pract Res Clin Obstet Gynaecol. 2018;48:103-14. DOI:10.1016/j.bpobgyn.2017.08.008
16. DiVall S, Merjaneh L. Adolescent Polycystic Ovary Syndrome: An Update. Pediatr Ann. 2019;48(8):e304-10. DOI:10.3928/19382359-20190729-01
17. Bellver J, Rodríguez-Tabernero L, Robles A, et al. Group of interest in Reproductive Endocrinology (GIER) of the Spanish Fertility Society (SEF). Polycystic ovary syndrome throughout a woman's life. J Assist Reprod Genet. 2018;35(1):25-39. DOI:10.1007/s10815-017-1047-7
18. Rodriguez-Paris D, Remlinger-Molenda A, Kurzawa R, et al. Psychiatric disorders in women with polycystic ovary syndrome. Psychiatr Pol. 2019;53(4):955-66. DOI:10.12740/PP/OnlineFirst/93105
19. Ezeh U, Huang A, Landay M, Azziz R. Long-Term Response of Hirsutism and Other Hyperandrogenic Symptoms to Combination Therapy in Polycystic Ovary Syndrome. J Womens Health (Larchmt). 2018;27(7):892-902.
20. Lizneva D, Gavrilova-Jordan L, Walker W, Azziz R. Androgen excess: Investigations and management. Best Pract Res Clin Obstet Gynaecol. 2016;37:98-118.
21. Lause M, Kamboj A, Fernandez Faith E. Dermatologic manifestations of endocrine disorders. Transl Pediatr. 2017;6(4):300-12.
22. Melibary YT. Hidradenitis suppurativa in a patient with hyperandrogenism, insulin-resistance and acanthosis nigricans (HAIR-AN syndrome). Dermatol Reports. 2018;10(1):7546.
23. Keen MA, Shah IH, Sheikh G. Cutaneous Manifestations of Polycystic Ovary Syndrome: A Cross-Sectional Clinical Study. Indian Dermatol Online J. 2017;8(2):104-10.
24. Glueck CJ, Goldenberg N. Characteristics of obesity in polycystic ovary syndrome: Etiology, treatment, and genetics. Metabolism. 2019;92:108-20.
25. Pasquali R, Oriolo C. Obesity and Androgens in Women. Front Horm Res. 2019;53:120-34.
26. Zheng SH, Li XL. Visceral adiposity index as a predictor of clinical severity and therapeutic outcome of PCOS. Gynecol Endocrinol. 2016;32(3):177-83.
27. Rodgers R, Avery J, Moore V, et al. Complex diseases and co-morbidities: polycystic ovary syndrome and type 2 diabetes mellitus. Endocr Connect. 2019:EC-18-0502.R2. DOI:10.1530/EC-18-0502
28. Belenkaya LV. Criteria of obesity for Asian population. Literature review. Acta Biomedica Scientifica. 2018;3(3):99-102 (in Russian).
29. Osibogun O, Ogunmoroti O, Michos ED. Polycystic ovary syndrome and cardiometabolic risk: Opportunities for cardiovascular disease prevention. Trends Cardiovasc Med. 2020;30(7):399-404.
30. Papadakis G, Kandaraki E, Papalou O, et al. Is cardiovascular risk in women with PCOS a real risk? Current insights. Minerva Endocrinol. 2017;42(4):340-55.
31. Meun C, Gunning MN, Louwers YV, et al. The cardiovascular risk profile of middle-aged women with polycystic ovary syndrome. Clin Endocrinol (Oxford). 2020;92(2):150-8.
32. Delitala AP, Capobianco G, Delitala G, et al. Polycystic ovary syndrome, adipose tissue and metabolic syndrome. Arch Gynecol Obstet. 2017;296(3):405-19.
33. Mulder CL, Lassi ZS, Grieger JA, et al. Cardio-metabolic risk factors among young infertile women: a systematic review and meta-analysis. BJOG. 2020;127(8):930-9.
34. Damone AL, Joham AE, Loxton D, et al. Depression, anxiety and perceived stress in women with and without PCOS: a community-based study. Psychol Med. 2019;49(9):1510-20.
35. Cooney LG, Dokras A. Depression and Anxiety in Polycystic Ovary Syndrome: Etiology and Treatment. Curr Psychiatry Rep. 2017;19(11):83.
36. Rodriguez-Paris D, Remlinger-Molenda A, Kurzawa R, et al. Psychiatric disorders in women with polycystic ovary syndrome. Psychiatr Pol. 2019;53(4):955-66.
37. Brutocao C, Zaiem F, Alsawas M, et al. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine. 2018;62(2):318-25.
38. Gibson-Helm M, Teede H, Dunaif A, et al. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2017;102(2):604-12.
39. Dokras A, Saini S, Gibson-Helm M, et al. Gaps in knowledge among physicians regarding diagnostic criteria and management of polycystic ovary syndrome. Fertil Steril. 2017;107(6):1380-6.e1.
40. Balen AH, Morley LC, Misso M, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: An analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update. 2016;22(6):687-708.
41. Tosi F. Implications of androgen assay accuracy in the phenotyping of women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2016;101(2):610-8.
42. Prilepskaya VN, Abakarova PR, Yarotskaya YeL. Modern Contraception and Women’s Quality of Life. Doctor.Ru. 2017;3(132):37-42 (in Russian).
43. Andersen M, Glintborg D. Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT? Eur J Endocrinol. 2018;179(3):D1-14. DOI:10.1530/EJE-18-0237
44. Anagnostis P, Tarlatzis BC, Kauffman RP. Polycystic ovarian syndrome (PCOS): Long-term metabolic consequences. Metabolism. 2018;86:33-43.
45. Nolan CJ, Prentki M. Insulin resistance and insulin hypersecretion in the metabolic syndrome and type 2 diabetes: Time for a conceptual framework shift. Diab Vasc Dis Res. 2019;16(2):118-27.
46. Pelanis R, Mellembakken JR, Sundström-Poromaa I, et al. The prevalence of Type 2 diabetes is not increased in normal-weight women with PCOS. Hum Reprod. 2017;32(11):2279-86.
47. Condorelli RA, Calogero AE, Di Mauro M, La Vignera S. PCOS and diabetes mellitus: from insulin resistance to altered beta pancreatic function, a link in evolution. Gynecol Endocrinol. 2017;33(9):665-7.
48. Jeanes YM, Reeves S. Metabolic consequences of obesity and insulin resistance in polycystic ovary syndrome: diagnostic and methodological challenges. Nutr Res Rev. 2017;30(1):97-105.
49. Osibogun O, Ogunmoroti O, Michos ED. Polycystic ovary syndrome and cardiometabolic risk: Opportunities for cardiovascular disease prevention. Trends Cardiovasc Med. 2020;30(7):399-404. DOI:10.1016/j.tcm.2019.08.010
50. Zhu RY, Wong YC, Yong EL. Sonographic evaluation of polycystic ovaries. Best Pract Res Clin Obstet Gynaecol. 2016;37:25-37.
51. Peña AS, Witchel SF, Hoeger KM, et al. Adolescent polycystic ovary syndrome according to the international evidence-based guideline. BMC Med. 2020;18(1):72. DOI:10.1186/s12916-020-01516-x
52. Meier RK. Polycystic Ovary Syndrome. Nurs Clin North Am. 2018;53(3):407-20. DOI:10.1016/j.cnur.2018.04.008
53. Cooney LG, Dokras A. Beyond fertility: polycystic ovary syndrome and long-term health. Fertil Steril. 2018;110(5):794-809. DOI:10.1016/j.fertnstert.2018.08.021
1 ФГБОУ ВО «Омский государственный медицинский университет» Минздрава России, Омск, Россия;
2 Клинико-диагностический центр «Ультрамед», Омск, Россия;
3 ООО «Многопрофильный центр современной медицины "Евромед"», Омск, Россия
*kravchenko.en@mail.ru
________________________________________________
Elena N. Kravchenko*1, Elena Yu. Khomutova1, Elmira N. Engurazova2, Maria S. Vorontsova3
1 Omsk State Medical University, Omsk, Russia;
2 Clinical and Diagnostic Center “Ultramed”, Omsk, Russia;
3 Multidisciplinary Center of Modern Medicine “Euromed”, Omsk, Russia
*kravchenko.en@mail.ru