Гормональная контрацепция у женщин с синдромом поликистозных яичников: контрацептивные и неконтрацептивные эффекты. Клиническая лекция

1. Yu O, Christ JP, Schulze-Rath R, et al. Incidence, prevalence, and trends in polycystic ovary syndrome diagnosis: a United States population-based study from 2006 to 2019. Am J Obstet Gynecol. 2023;229(1):39.e1-9e12. DOI:10.1016/j.ajog.2023.04.010
2. Shilpa K, Earlina A, Larysa S. The Clinical Manifestations of Polycystic Ovary Syndrome (PCOS) and The Treatment Options. European Journal of Biology and Medical Science Research. 2023;11:57-91.
3. Tomlinson JA, Pinkney JH, Evans P, et al. Screening for diabetes and cardiometabolic disease in women with polycystic ovary syndrome. The British Journal of Diabetes &Vascular Disease. 2013;13(3):115-23. DOI:10.1177/1474651413495571
4. Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-49. DOI:10.1210/clinem/dgad463
5. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41-7. DOI:10.1093/humrep/deh098
6. Christ JP, Cedars MI. Current Guidelines for Diagnosing PCOS. Diagnostics (Basel). 2023;13(6):1113. DOI:10.3390/diagnostics13061113
7. Fischer-Holzhausen S, Röblitz S. Hormonal regulation of ovarian follicle growth in humans: Model-based exploration of cycle variability and parameter sensitivities. J Theor Biol. 2022;547:111150. DOI:10.1016/j.jtbi.2022.111150
8. De Leo V, Musacchio MC, Cappelli V, et al. Genetic, hormonal and metabolic aspects of PCOS: an update. Reprod Biol Endocrinol. 2016;14(1):38. DOI:10.1186/s12958-016-0173-x
9. Wawrzkiewicz-Jałowiecka A, Kowalczyk K, Trybek P, et al. In Search of New Therapeutics-Molecular Aspects of the PCOS Pathophysiology: Genetics, Hormones, Metabolism and Beyond. Int J Mol Sci. 2020;21(19):7054. DOI:10.3390/ijms21197054
10. Lie Fong S, Laven JSE, Duhamel A, Dewailly D. Polycystic ovarian morphology and the diagnosis of polycystic ovary syndrome: redefining threshold levels for follicle count and serum anti-Müllerian hormone using cluster analysis. Hum Reprod. 2017;32(8):1723-71. DOI:10.1093/humrep/dex226
11. Silva MSB, Giacobini P. New insights into anti-Müllerian hormone role in the hypothalamic-pituitary-gonadal axis and neuroendocrine development. Cell Mol Life Sci. 2021;78(1):1-6. DOI:10.1007/s00018-020-03576-x
12. Niethammer B, Körner C, Schmidmayr M, et al. Non-reproductive Effects of Anovulation: Bone Metabolism in the Luteal Phase of Premenopausal Women Differs between Ovulatory and Anovulatory Cycles. Geburtshilfe Frauenheilkd. 2015;75(12):1250-7. DOI:10.1055/s-0035-1558298
13. Norman RJ, Morman R, Teede HJ. "Tis but thy name that is my enemy"–the problem with the naming of polycystic ovary syndrome. Fertil Steril. 2023;120(2):249-50. DOI:10.1016/j.fertnstert.2023.03.028
14. Tosi F, Bonora E, Moghetti P. Insulin resistance in a large cohort of women with polycystic ovary syndrome: a comparison between euglycaemic-hyperinsulinaemic clamp and surrogate indexes. Hum Reprod. 2017;32(12):2515-51. DOI:10.1093/humrep/dex308
15. Cassar S, Misso ML, Hopkins WG, et al. Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Hum Reprod. 2016;31(11):2619-61. DOI:10.1093/humrep/dew243
16. Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(6):618-37. DOI:10.1093/humupd/dms030
17. Ovalle F, Azziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertil Steril. 2002;77(6):1095-105. DOI:10.1016/s0015-0282(02)03111-4
18. Unluhizarci K, Karaca Z, Kelestimur F. Role of insulin and insulin resistance in androgen excess disorders. World J Diabetes. 2021;12(5):616-29. DOI:10.4239/wjd.v12.i5.616
19. Joham AE, Norman RJ, Stener-Victorin E, et al. Polycystic ovary syndrome. Lancet Diabetes Endocrinol. 2022;10(9):668-80. DOI:10.1016/S2213-8587(22)00163-2
20. Carlomagno G, Unfer V, Roseff S. The D-chiro-inositol paradox in the ovary. Fertil Steril. 2011;95(8):2515-6. DOI:10.1016/j.fertnstert.2011.05.027
21. Diamanti-Kandarakis E, Papalou O, Kandaraki EA. The Role of Androgen Excess on Insulin Sensitivity in Women. Front Horm Res. 2019;53:50-64. DOI:10.1159/000494902
22. Tuorila K, Ollila MM, Järvelin MR, et al. Hyperandrogenemia in Early Adulthood Is an Independent Risk Factor for Abnormal Glucose Metabolism in Middle Age. J Clin Endocrinol Metab. 2021;106(11):e4621-33. DOI:10.1210/clinem/dgab456
23. Пустотина О.А., Расулова И.А. Влияние миоинозитола и Д-хироинозитола в соотношении 40:1 на гормональные и метаболические показатели у женщин с синдромом поликистозных яичников. Акушерство и гинекология. 2023;9:146-54 [Pustotina OA, Rasulova IA. Vliianie mioinozitola i D-khiroinozitola v sootnoshenii 40:1 na gormonal'nye i metabolicheskie pokazateli u zhenshchin s sindromom polikistoznykh iaichnikov. Akusherstvo i ginekologiia. 2023;9:146-54 (in Russian)]. 
24. Unfer V, Dinicola S, Russo M. A PCOS Paradox: Does Inositol Therapy Find a Rationale in All the Different Phenotypes? Int J Mol Sci. 2023;24(7). DOI:10.3390/ijms24076213
25. Alviggi C, Conforti A, De Rosa P, et al. The Distribution of Stroma and Antral Follicles Differs between Insulin-Resistance and Hyperandrogenism-Related Polycystic Ovarian Syndrome. Front Endocrinol (Lausanne). 2017;8:117. DOI:10.3389/fendo.2017.00117
26. Genazzani AD, Genazzani AR. Polycystic Ovary Syndrome as Metabolic Disease: New Insights on Insulin Resistance. touchREV Endocrinol. 2023;19(1):71-7. DOI:10.17925/EE.2023.19.1.71
27. Palomba S, Piltonen TT, Giudice LC. Endometrial function in women with polycystic ovary syndrome: a comprehensive review. Hum Reprod Update. 2021;27(3):584-618. DOI:10.1093/humupd/dmaa051
28. Moghetti P, Tosi F, Bonin C, et al. Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. J Clin Endocrinol Metab. 2013;98(4):E628-37. DOI:10.1210/jc.2012-3908
29. Dai S, Zhang H, Yang F, et al. Effects of IGF-1 on the Three-Dimensional Culture of Ovarian Preantral Follicles and Superovulation Rates in Mice. Biology (Basel). 2022;11(6). DOI:10.3390/biology11060833
30. Young CH, Snow B, DeVore SB, et al. Progesterone stimulates histone citrullination to increase IGFBP1 expression in uterine cells. Reproduction. 2021;162(2):117-27. DOI:10.1530/REP-21-0132
31. Пустотина О.А. Фенотипы синдрома поликистозных яичников. Фарматека. 2023;30(4-5):156-63 [Pustotina OA. Polycystic ovary syndrome phenotypes. Pharmateca.
2023;30(4-5):156-63 (in Russian)]. DOI:10.18565/pharmateca.2023.4-5.156-163
32. WHO/SRH and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), Knowledge SUCCESS. Family Planning: A Global Handbook for Providers (2022 update). Baltimore and Geneva: CCP and WHO, 2022.
33. Национальные медицинские критерии приемлемости методов контрацепции (Адаптированный документ «Медицинские критерии приемлемости использования методов контрацепции ВОЗ, 5-е издание, 2015»). М. 2023 [Natsional'nye meditsinskie kriterii priemlemosti metodov kontratseptsii (Adaptirovannyi dokument «Meditsinskie kriterii priemlemosti ispol'zovaniia metodov kontratseptsii VOZ, 5-e izdanie, 2015»). Moscow. 2023 (in Russian)].
34. Family Planing: A global handbook for providers. Update 4th еdition. 2022. Available at: www.fphandbook.org. Accessed: 15.08.2024.
35. Schrager S, Larson M, Carlson J, et al. Beyond Birth Control: Noncontraceptive Benefits of Hormonal Methods and Their Key Role in the General Medical Care of Women. J Womens Health (Larchmt). 2020;29(7):937-43. DOI:10.1089/jwh.2019.7731
36. Naessén S, Carlström K, Byström B, et al. Effects of an antiandrogenic oral contraceptive on appetite and eating behavior in bulimic women. Psychoneuroendocrinology. 2007;32(5):548-4. DOI:10.1016/j.psyneuen.2007.03.008
37. Honma S, Iwamura S, Iizuka K, et al. Identification and anti-androgenic activity of the metabolites of 17alpha-acetoxy-6-chloropregna-4,6-diene-3,20-dione (chlormadinone acetate) in the rat, rabbit, dog and man. Chem Pharm Bull (Tokyo). 1977;25(8):2019-31. DOI:10.1248/cpb.25.2019
38. Пеcтрикова Т.Ю., Юрасова Е.А., Никоноркина И.Ю. Оценка лечебных эффектов и влияния на сексуальную активность препарата Белара. Гинекология. 2015;17(3):88-92 [Pestrikova TYu, Yurasova EA., Nikonorkina IYu. Evaluation of therapeutic effects and impact on the sexual activity of Belara. Gynecology. 2015;17(3):88-92 (in Russian)].
39. Huber JC, Heskamp ML, Schramm GA. Effect of an oral contraceptive with chlormadinone acetate on depressive mood: analysis of data from four observational studies. Clin Drug Investig. 2008;28(12):783-91. DOI:10.2165/0044011-200828120-00006
40. Contreras CM, Azamar-Arizmendi G, Saavedra M, Hernández-Lozano M. A five-day gradual reduction regimen of chlormadinone reduces premenstrual anxiety and depression: a pilot study. Arch Med Res. 2006;37(7):907-13. DOI:10.1016/j.arcmed.2006.05.001

________________________________________________

1. Yu O, Christ JP, Schulze-Rath R, et al. Incidence, prevalence, and trends in polycystic ovary syndrome diagnosis: a United States population-based study from 2006 to 2019. Am J Obstet Gynecol. 2023;229(1):39.e1-9e12. DOI:10.1016/j.ajog.2023.04.010
2. Shilpa K, Earlina A, Larysa S. The Clinical Manifestations of Polycystic Ovary Syndrome (PCOS) and The Treatment Options. European Journal of Biology and Medical Science Research. 2023;11:57-91.
3. Tomlinson JA, Pinkney JH, Evans P, et al. Screening for diabetes and cardiometabolic disease in women with polycystic ovary syndrome. The British Journal of Diabetes &Vascular Disease. 2013;13(3):115-23. DOI:10.1177/1474651413495571
4. Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-49. DOI:10.1210/clinem/dgad463
5. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41-7. DOI:10.1093/humrep/deh098
6. Christ JP, Cedars MI. Current Guidelines for Diagnosing PCOS. Diagnostics (Basel). 2023;13(6):1113. DOI:10.3390/diagnostics13061113
7. Fischer-Holzhausen S, Röblitz S. Hormonal regulation of ovarian follicle growth in humans: Model-based exploration of cycle variability and parameter sensitivities. J Theor Biol. 2022;547:111150. DOI:10.1016/j.jtbi.2022.111150
8. De Leo V, Musacchio MC, Cappelli V, et al. Genetic, hormonal and metabolic aspects of PCOS: an update. Reprod Biol Endocrinol. 2016;14(1):38. DOI:10.1186/s12958-016-0173-x
9. Wawrzkiewicz-Jałowiecka A, Kowalczyk K, Trybek P, et al. In Search of New Therapeutics-Molecular Aspects of the PCOS Pathophysiology: Genetics, Hormones, Metabolism and Beyond. Int J Mol Sci. 2020;21(19):7054. DOI:10.3390/ijms21197054
10. Lie Fong S, Laven JSE, Duhamel A, Dewailly D. Polycystic ovarian morphology and the diagnosis of polycystic ovary syndrome: redefining threshold levels for follicle count and serum anti-Müllerian hormone using cluster analysis. Hum Reprod. 2017;32(8):1723-71. DOI:10.1093/humrep/dex226
11. Silva MSB, Giacobini P. New insights into anti-Müllerian hormone role in the hypothalamic-pituitary-gonadal axis and neuroendocrine development. Cell Mol Life Sci. 2021;78(1):1-6. DOI:10.1007/s00018-020-03576-x
12. Niethammer B, Körner C, Schmidmayr M, et al. Non-reproductive Effects of Anovulation: Bone Metabolism in the Luteal Phase of Premenopausal Women Differs between Ovulatory and Anovulatory Cycles. Geburtshilfe Frauenheilkd. 2015;75(12):1250-7. DOI:10.1055/s-0035-1558298
13. Norman RJ, Morman R, Teede HJ. "Tis but thy name that is my enemy"–the problem with the naming of polycystic ovary syndrome. Fertil Steril. 2023;120(2):249-50. DOI:10.1016/j.fertnstert.2023.03.028
14. Tosi F, Bonora E, Moghetti P. Insulin resistance in a large cohort of women with polycystic ovary syndrome: a comparison between euglycaemic-hyperinsulinaemic clamp and surrogate indexes. Hum Reprod. 2017;32(12):2515-51. DOI:10.1093/humrep/dex308
15. Cassar S, Misso ML, Hopkins WG, et al. Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Hum Reprod. 2016;31(11):2619-61. DOI:10.1093/humrep/dew243
16. Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(6):618-37. DOI:10.1093/humupd/dms030
17. Ovalle F, Azziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertil Steril. 2002;77(6):1095-105. DOI:10.1016/s0015-0282(02)03111-4
18. Unluhizarci K, Karaca Z, Kelestimur F. Role of insulin and insulin resistance in androgen excess disorders. World J Diabetes. 2021;12(5):616-29. DOI:10.4239/wjd.v12.i5.616
19. Joham AE, Norman RJ, Stener-Victorin E, et al. Polycystic ovary syndrome. Lancet Diabetes Endocrinol. 2022;10(9):668-80. DOI:10.1016/S2213-8587(22)00163-2
20. Carlomagno G, Unfer V, Roseff S. The D-chiro-inositol paradox in the ovary. Fertil Steril. 2011;95(8):2515-6. DOI:10.1016/j.fertnstert.2011.05.027
21. Diamanti-Kandarakis E, Papalou O, Kandaraki EA. The Role of Androgen Excess on Insulin Sensitivity in Women. Front Horm Res. 2019;53:50-64. DOI:10.1159/000494902
22. Tuorila K, Ollila MM, Järvelin MR, et al. Hyperandrogenemia in Early Adulthood Is an Independent Risk Factor for Abnormal Glucose Metabolism in Middle Age. J Clin Endocrinol Metab. 2021;106(11):e4621-33. DOI:10.1210/clinem/dgab456
23. Pustotina OA, Rasulova IA. Vliianie mioinozitola i D-khiroinozitola v sootnoshenii 40:1 na gormonal'nye i metabolicheskie pokazateli u zhenshchin s sindromom polikistoznykh iaichnikov. Akusherstvo i ginekologiia. 2023;9:146-54 (in Russian). 
24. Unfer V, Dinicola S, Russo M. A PCOS Paradox: Does Inositol Therapy Find a Rationale in All the Different Phenotypes? Int J Mol Sci. 2023;24(7). DOI:10.3390/ijms24076213
25. Alviggi C, Conforti A, De Rosa P, et al. The Distribution of Stroma and Antral Follicles Differs between Insulin-Resistance and Hyperandrogenism-Related Polycystic Ovarian Syndrome. Front Endocrinol (Lausanne). 2017;8:117. DOI:10.3389/fendo.2017.00117
26. Genazzani AD, Genazzani AR. Polycystic Ovary Syndrome as Metabolic Disease: New Insights on Insulin Resistance. touchREV Endocrinol. 2023;19(1):71-7. DOI:10.17925/EE.2023.19.1.71
27. Palomba S, Piltonen TT, Giudice LC. Endometrial function in women with polycystic ovary syndrome: a comprehensive review. Hum Reprod Update. 2021;27(3):584-618. DOI:10.1093/humupd/dmaa051
28. Moghetti P, Tosi F, Bonin C, et al. Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. J Clin Endocrinol Metab. 2013;98(4):E628-37. DOI:10.1210/jc.2012-3908
29. Dai S, Zhang H, Yang F, et al. Effects of IGF-1 on the Three-Dimensional Culture of Ovarian Preantral Follicles and Superovulation Rates in Mice. Biology (Basel). 2022;11(6). DOI:10.3390/biology11060833
30. Young CH, Snow B, DeVore SB, et al. Progesterone stimulates histone citrullination to increase IGFBP1 expression in uterine cells. Reproduction. 2021;162(2):117-27. DOI:10.1530/REP-21-0132
31. Pustotina OA. Polycystic ovary syndrome phenotypes. Pharmateca. 2023;30(4-5):156-63 (in Russian). DOI:10.18565/pharmateca.2023.4-5.156-163
32. WHO/SRH and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), Knowledge SUCCESS. Family Planning: A Global Handbook for Providers (2022 update). Baltimore and Geneva: CCP and WHO, 2022.
33. Natsional'nye meditsinskie kriterii priemlemosti metodov kontratseptsii (Adaptirovannyi dokument «Meditsinskie kriterii priemlemosti ispol'zovaniia metodov kontratseptsii VOZ, 5-e izdanie, 2015»). Moscow. 2023 (in Russian).
34. Family Planing: A global handbook for providers. Update 4th еdition. 2022. Available at: www.fphandbook.org. Accessed: 15.08.2024.
35. Schrager S, Larson M, Carlson J, et al. Beyond Birth Control: Noncontraceptive Benefits of Hormonal Methods and Their Key Role in the General Medical Care of Women. J Womens Health (Larchmt). 2020;29(7):937-43. DOI:10.1089/jwh.2019.7731
36. Naessén S, Carlström K, Byström B, et al. Effects of an antiandrogenic oral contraceptive on appetite and eating behavior in bulimic women. Psychoneuroendocrinology. 2007;32(5):548-4. DOI:10.1016/j.psyneuen.2007.03.008
37. Honma S, Iwamura S, Iizuka K, et al. Identification and anti-androgenic activity of the metabolites of 17alpha-acetoxy-6-chloropregna-4,6-diene-3,20-dione (chlormadinone acetate) in the rat, rabbit, dog and man. Chem Pharm Bull (Tokyo). 1977;25(8):2019-31. DOI:10.1248/cpb.25.2019
38. Pestrikova TYu, Yurasova EA., Nikonorkina IYu. Evaluation of therapeutic effects and impact on the sexual activity of Belara. Gynecology. 2015;17(3):88-92 (in Russian).
39. Huber JC, Heskamp ML, Schramm GA. Effect of an oral contraceptive with chlormadinone acetate on depressive mood: analysis of data from four observational studies. Clin Drug Investig. 2008;28(12):783-91. DOI:10.2165/0044011-200828120-00006
40. Contreras CM, Azamar-Arizmendi G, Saavedra M, Hernández-Lozano M. A five-day gradual reduction regimen of chlormadinone reduces premenstrual anxiety and depression: a pilot study. Arch Med Res. 2006;37(7):907-13. DOI:10.1016/j.arcmed.2006.05.001

О.А. Пустотина*

ЧОУ ДПО «Академия медицинского образования им. Ф.И. Иноземцева», Санкт-Петербург, Россия
*pustotina@gmail.com

________________________________________________

Olga A. Pustotina*

Inozemtsev Academy of Medical Education, Saint Petersburg, Russia
*pustotina@gmail.com