RESUMO
PURPOSE: Polycystic ovary syndrome (PCOS) is an endocrine, metabolic, and reproductive disorder which, according to the Rotterdam criteria, affects up to 24% of women of childbearing age. Although the prevalence of infertility in this subpopulation of women is high, the optimal treatment has not been fully established yet. Insulin resistance is considered to be an important mechanism involved in the development of PCOS; hence, the aim of this narrative review is to present an overview of the current pharmacological insulin-sensitizing treatment modalities for infertile women with PCOS. METHODS: A MEDLINE and PubMed search for the years 1990-2023 was performed using a combination of keywords. Clinical trials with insulin sensitizers used for infertility treatment as well as analyses of systematic reviews and meta-analyses were evaluated. When deemed necessary, additional articles referenced in the retrieved papers were included in this narrative review. RESULTS: Several insulin-sensitizing compounds and various therapeutical protocols are available for infertility treatment of women with PCOS. Metformin is the most common adjuvant medication to induce ovulation in infertile women with PCOS and is more frequently administered in combination with clomiphene citrate than on its own. Recently, inositol and glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as possible options for infertility treatment in PCOS. CONCLUSION: The future of medical treatment of PCOS women with infertility lies in a personalized pharmacological approach, which involves various compounds with different mechanisms of action that could modify ovarian function and endometrial receptivity, ultimately leading to better overall reproductive outcomes in these women.
Assuntos
Infertilidade Feminina , Metformina , Síndrome do Ovário Policístico , Feminino , Humanos , Síndrome do Ovário Policístico/tratamento farmacológico , Infertilidade Feminina/tratamento farmacológico , Insulina , Indução da Ovulação/métodos , Revisões Sistemáticas como Assunto , Clomifeno/uso terapêutico , Metformina/uso terapêutico , Hipoglicemiantes/uso terapêuticoRESUMO
Aging and its underlying pathophysiological background has always attracted the attention of the scientific society. Defined as the gradual, time-dependent, heterogeneous decline of physiological functions, aging is orchestrated by a plethora of molecular mechanisms, which vividly interact to alter body homeostasis. The ability of an organism to adjust to these alterations, in conjunction with the dynamic effect of various environmental stimuli across lifespan, promotes longevity, frailty or disease. Endocrine function undergoes major changes during aging, as well. Specifically, alterations in hormonal networks and concomitant hormonal deficits/excess, augmented by poor sensitivity of tissues to their action, take place. As hypothalamic-pituitary unit is the central regulator of crucial body functions, these alterations can be translated in significant clinical sequelae that can impair the quality of life and promote frailty and disease. Delineating the hormonal signaling alterations that occur across lifespan and exploring possible remedial interventions could possibly help us improve the quality of life of the elderly and promote longevity.
Assuntos
Envelhecimento/metabolismo , Sistema Endócrino/metabolismo , Estresse Oxidativo , Adjuvantes Imunológicos/uso terapêutico , Androgênios/uso terapêutico , Antioxidantes/uso terapêutico , Ritmo Circadiano , Desidroepiandrosterona/uso terapêutico , Diabetes Mellitus Tipo 2/metabolismo , Dietoterapia , Terapia de Reposição de Estrogênios , Retroalimentação Fisiológica , Feminino , Preservação da Fertilidade , Gonadotropinas/metabolismo , Terapia de Reposição Hormonal , Humanos , Hiperandrogenismo/metabolismo , Hipertireoidismo/metabolismo , Hipertireoidismo/terapia , Hipoglicemiantes/uso terapêutico , Hipogonadismo/tratamento farmacológico , Hipogonadismo/metabolismo , Sistema Hipotálamo-Hipofisário/metabolismo , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/metabolismo , Células Secretoras de Insulina/metabolismo , Masculino , Menopausa/metabolismo , Reserva Ovariana , Medicina de Precisão , Qualidade de Vida , Transplante de Células-Tronco , Células-Tronco , Testosterona/uso terapêutico , Glândula Tireoide , Equilíbrio HidroeletrolíticoRESUMO
Polycystic ovary syndrome (PCOS) is a common metabolic and reproductive disorder in women. An increased cardiovascular risk has to be anticipated in PCOS as it is a metabolically unstable condition. Among cardiovascular risk factors, dyslipidemia is certainly the most persistent and highly prevalent. Predominant observation is an elevation of LDL cholesterol in all PCOS patients. Decreased concentrations of HDL cholesterol are found in obese PCOS from the third decade of life onwards while triglycerides start to rise from the second decade of life. PCOS is associated with oxidative stress, namely increased production of free radicals followed by decreased serum antioxidant levels and antioxidant enzyme activity. Broad range of endocrine and metabolic disturbances like obesity, hyperinsulinemia as well as dyslipidemia might be responsible for PCOS-associated oxidative stress. Therapeutic interventions in PCOS women based on lifestyle modification as well as use of insulin sensitizers did not show significant effect on dyslipidemia. Statins are considered to be a group of promising agents that are safe and effective in improving total cholesterol, LDL cholesterol and triglycerides, and possess antioxidant activity. Supplementation with omega-3 fatty acids, α-lipoic acid and N-acetylcysteine is considered to have an anti-inflammatory and antioxidant effect and to improve dyslipidemia and insulin sensitivity in PCOS women.