A review of therapeutic options for managing the metabolic aspects of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Metabolic sequelae associated with PCOS range from insulin resistance to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Insulin resistance plays a significant role in the pathophysiology of PCOS and it is a reliable marker for cardiometabolic risk. Although insulin sensitising agents such as metformin have been traditionally used for managing metabolic aspects of PCOS, their efficacy is low in terms of weight reduction and cardiovascular risk reduction compared with newer agents such as incretin mimetics and SGLT2 inhibitors. With current pharmaceutical advances, potential therapeutic options have increased, giving patients and clinicians more choices. Incretin mimetics are a promising therapy with a unique metabolic target that could be used widely in the management of PCOS. Likewise, bariatric procedures have become less invasive and result in effective weight loss and the reversal of metabolic morbidities in some patients. Therefore, surgical treatment targeting weight loss becomes increasingly common in the management of obese women with PCOS. Newer emerging therapies, including twincretins, triple GLP-1 agonists, glucagon receptor antagonists and imeglemin, are promising therapeutic options for treating T2DM. Given the similarity of metabolic and pathological features between PCOS and T2DM and the variety of therapeutic options, there is the potential to widen our strategy for treating metabolic disorders in PCOS in parallel with current therapeutic advances. The review was conducted in line with the recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018.

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Adiposity and metabolic dysfunction in polycystic ovary syndrome

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2015-0008 ◽

2015 ◽

Vol 21 (2) ◽

Cited By ~ 7

Author(s):

Susan Sam

Keyword(s):

Insulin Resistance ◽

Adipose Tissue ◽

Polycystic Ovary Syndrome ◽

Metabolic Disorders ◽

Polycystic Ovary ◽

Reproductive Age ◽

Metabolic Dysfunction ◽

Obese Women ◽

Ovary Syndrome ◽

Insulin Resistant

AbstractPolycystic ovary syndrome (PCOS) is the most common hormonal disorder among reproductive-age women and is associated with a high risk for metabolic disorders. Adiposity and insulin resistance are two prevalent conditions in PCOS and the likely culprits for the heightened metabolic risk. Up to 60% of women with PCOS are considered to be overweight or obese, and even among non-obese women with PCOS there is an increased accumulation of adipose tissue in abdominal depots. Insulin resistance in PCOS is unique and independent of obesity, as even non-obese women with this condition are frequently insulin resistant. However, obesity substantially aggravates the insulin resistance and the metabolic and reproductive abnormalities in women with PCOS. Recently, it has been shown that many aspects of adipose tissue function in PCOS are abnormal, and these abnormalities likely predispose to development of insulin resistance even in the absence of obesity. This review provides an overview of these abnormalities and their impact on development of metabolic disorders. At the end, an overview of the therapeutic options for management of adiposity and its complications in PCOS are discussed.

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Insulin Resistance and Weight Loss in Obese Women with Polycystic Ovary Syndrome Treated with Liraglutide—Single Institution Experience

Diabetes ◽

10.2337/db18-2452-pub ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 2452-PUB

Author(s):

ANDREW CRAWFORD ◽

LAURA G. COONEY ◽

NICOLE JOCHYM ◽

ANUJA DOKRAS ◽

ANASTASSIA AMARO

Keyword(s):

Insulin Resistance ◽

Weight Loss ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Obese Women ◽

Single Institution ◽

Ovary Syndrome

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Effect of fennel supplementation along with high-protein, low-carbohydrate weight-loss diet on insulin resistance and percentage of fat and muscle mass in overweight/obese women with polycystic ovary syndrome

Journal of Functional Foods ◽

10.1016/j.jff.2020.103848 ◽

2020 ◽

Vol 67 ◽

pp. 103848

Author(s):

Elham Hosseini Marnani ◽

Akram Ghadiri-Anari ◽

Nahid Ramezani-Jolfaie ◽

Mohammad Mohammadi ◽

Nooshin abdollahi ◽

...

Keyword(s):

Insulin Resistance ◽

Weight Loss ◽

Polycystic Ovary Syndrome ◽

Muscle Mass ◽

Polycystic Ovary ◽

High Protein ◽

Obese Women ◽

Ovary Syndrome ◽

Weight Loss Diet ◽

Low Carbohydrate

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Effect on Insulin-Stimulated Release of D-Chiro-Inositol-Containing Inositolphosphoglycan Mediator during Weight Loss in Obese Women with and without Polycystic Ovary Syndrome

International Journal of Endocrinology ◽

10.1155/2016/7631804 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Kai I. Cheang ◽

Sakita N. Sistrun ◽

Kelley S. Morel ◽

John E. Nestler

Keyword(s):

Insulin Resistance ◽

Weight Loss ◽

Insulin Sensitivity ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Obese Women ◽

Ovary Syndrome ◽

Matsuda Index ◽

Normal Women ◽

The Relationship

Background.A deficiency of D-chiro-inositol-inositolphosphoglycan mediator (DCI-IPG) may contribute to insulin resistance in polycystic ovary syndrome (PCOS). Whether the relationship between impaired DCI-IPG release and insulin resistance is specific to PCOS rather than obesity is unknown. We assessed insulin-released DCI-IPG and its relationship to insulin sensitivity at baseline and after weight loss in obese women with and without PCOS.Methods.Obese PCOS (n=16) and normal (n=15) women underwent 8 weeks of a hypocaloric diet. The Matsuda index, area under the curve DCI-IPG (AUCDCI-IPG),AUCinsulin, andAUCDCI-IPG/AUCinsulinwere measured during a 2 hr OGTT at baseline and 8 weeks.Results.PCOS women had lowerAUCDCI-IPG/AUCinsulinat baseline and a significant relationship betweenAUCDCI-IPG/AUCinsulinand Matsuda index (p=0.0003), which was not present in controls. Weight loss was similar between PCOS (−4.08 kg) and normal women (−4.29 kg,p=0.6281). Weight loss in PCOS women did not change the relationship betweenAUCDCI-IPG/AUCinsulinand Matsuda index (p=0.0100), and this relationship remained absent in control women.Conclusion.The association betweenAUCDCI-IPG/AUCinsulinand insulin sensitivity was only found in PCOS but not in normal women, and this relationship was unaffected by weight loss. DCI and its messenger may contribute to insulin resistance in PCOS independent of obesity.

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Polycystic ovary syndrome and probiotics: a natural approach to an inflammatory disease

Current Women s Health Reviews ◽

10.2174/1573404816999200601162506 ◽

2020 ◽

Vol 16 ◽

Author(s):

Antonio Schiattarella ◽

Gaetano Riemma ◽

Marco La Verde ◽

Gianluigi Franci ◽

Annalisa Chianese ◽

...

Keyword(s):

Insulin Resistance ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Critical Role ◽

Reproductive Age ◽

Ovary Syndrome ◽

Natural Approach ◽

New Treatment ◽

Gut Microbial Community ◽

New Evidence

: Polycystic ovary syndrome (PCOS) is a condition that affects about 15% of women of reproductive age and is correlated with infertility, insulin resistance, and obesity. The etiology of PCOS is multifactorial and genetic, endocrine, and metabolic causes were involved. New evidence suggests a link between microorganisms residing in the digestive tracts of humans and the development of PCOS. Moreover, an imbalance in the gut microbial community could be a possible factor for the onset of insulin resistance and obesity. Hyperandrogenism, a key feature of PCOS, could also play a critical role in shaping the microbiome community. Probiotics could modify the gut microbiota and serve as a potential treatment for PCOS. Here we disclose the association between PCOS and intestinal microbiota and the possible role of probiotics as a new treatment approach.

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Evidence for competing effects of body mass, hyperinsulinemia, insulin resistance, and androgens on leptin levels among lean, overweight, and obese women with polycystic ovary syndrome

Fertility and Sterility ◽

10.1016/s0015-0282(02)03303-4 ◽

2002 ◽

Vol 78 (3) ◽

pp. 479-486 ◽

Cited By ~ 45

Author(s):

Karen E Remsberg ◽

Evelyn O Talbott ◽

Jeanne V Zborowski ◽

Rhobert W Evans ◽

Kathleen McHugh-Pemu

Keyword(s):

Insulin Resistance ◽

Polycystic Ovary Syndrome ◽

Body Mass ◽

Polycystic Ovary ◽

Obese Women ◽

Ovary Syndrome

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Polycystic ovary syndrome: reproductive aspects

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.0851 ◽

2011 ◽

pp. 1229-1234

Author(s):

Sophie Catteau-Jonard ◽

Cécile Gallo ◽

Didier Didier

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Reproductive Age ◽

Therapeutic Approaches ◽

Women Of Reproductive Age ◽

Ovary Syndrome ◽

Common Cause ◽

The Metabolic Syndrome

The polycystic ovary syndrome (PCOS) is the most common cause of anovulation and hyperandrogenism in women, affecting between 5 and 10% of women of reproductive age worldwide (1). Although this difficult topic in endocrine gynaecology is under extensive research, controversies still remain about the pathophysiology, diagnosis, and therapy of PCOS. The PCOS phenotype can be structured in three components: manifestations of anovulation, hyperandrogenism, and the metabolic syndrome (of which hyperinsulinaemia secondary to insulin resistance is the central abnormality). The latter two are addressed in other chapters. Our knowledge about the mechanism of disturbed folliculogenesis in PCOS that is responsible for its reproductive aspects has much increased these last years, thus opening new avenues for the diagnostic and therapeutic approaches.

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