Polycystic Ovary Syndrome: new treatment possibilities

For a long time Polycystic Ovary Syndrome (PCOS) treatment was based on oral contraceptives or ovulation inducer

polycystic ovary

polycystic ovary syndrome

drugs: the firsts were particularly employed because of their power against Hirsutism and Hyperandrogenism symptoms, the latters were chosen if the patient had a mating desire. Contraceptives (the most famous is the DIANE) were often the only way to stop Amenorrhea (absence of menstruation) and ensuring flows after (artificial) suspension. Further, they protected from the risk of endometrial Hyperplasia, particularly present in obese patients.

Inducers (The moist famous is the CLOMID) could not be repeatedly given to the patient and the only alternative to them was a surgery by ovarian wedge resection or ovarian drilling (a series of small perforations on the surface of the ovary generally conducted in laparoscopy). Oral contraceptives, ovulation-inducing drugs and surgery have been the only therapeutic options until it was studied an important metabolic component in both Polycystic Ovary Syndrome and its lighter and more common version Micropolycystic Ovary Syndrome. It is the the role of insulin that attracts the attention of researchers (picture on the right: a cover of a 1987 work of mine on this argument) and the research conducted at the University of Ancona clearly showed an altered insulin response in Patients with Polycystic Ovary Syndrome and Micropolycystic Ovary Syndrome.

Over the years the active treatments on metabolism and insulin secretions and in particular the use of METFORMIN have significantly changed the therapeutic strategy with greater successes.

gior_it_fert_ster_1987

In 1987, Dr. Di Prospero described alterations in glucose and insulin metabolism in patients with Polycystic Ovary Syndrome.

Oral antidiabetic medicines, usually given in combination with oral contraceptive pills because of their possible teratogenic risk, have led to an effective treatment of Polycystic Ovary Syndrome, allowing reaching that necessary dietetic and cosmetic achievements faster. Lifestyle and everyday nutrition were the real key points of any therapeutic strategy and an effective therapy against Polycystosis could not be based only on oral contraceptives. This conceptual revolution was extended to the treatment of ovulation induction that seemed immediately more effective when combined with metformin and a diet.

Oral antidiabetics, besides the potential risks for the fetus, have important side effects and the demonstration that such a target could be achieved with INOSITOL (carbocyclic polyol which the most common form in nature is myo-inositol and it is still present in other isomeric forms such as chiro-inositol) determined a significant therapeutic innovation. Inositol in the most active isomeric forms made it possible to handle the Polycystic Ovary Syndrome (PCOS) and the Micropolycystic Ovary Syndrome in a more physiological way than previously. Diet and Phisical Activity, after these conceptual changes, revealed a renewed interest and now a lot of women have spontaneous menstruations and ovulations without any medication.

As part of these new strategies (in particular of metabolic intervention) some kind of PROTEIN SUPLLEMENTS are in evidence because, in addition to a higher energy consumption positively affect glucose-insulinemic metabolism and easily solve without side effects situations that would otherwise only be managed with medications. So, it is more frequent the combination of protein supplements with Inositol in the context of diet plans and aerobic exercise.

Now the PCOS and Micropolycystic Ovary Syndrome have an effective therapy and for many girls and women there is a possible solution to a problem previously considered almost unsolvable. Some situations exist, like some patients afflicted by an acute Metabolic Syndrome or patients who require more time and more attention, but we can affirm that the situation has changed for them. They more and more rarely have to recourse to wedge resection surgery or ovarian drilling (a micrometric multiple perforation of ovarian surface).

Relating to innovative treatments strategies D3 Vitamin deserve a particular attention. This fact is recent but it seems that in women with PCOS and Micropolycystic Ovary Syndrome there is often a shortage of D3 Vitamin and a correction of this deficit (fairly simple) can be of great benefit. As I said, this fact is recent and further studies are in progress.

All these new therapeutic options undoubtedly has a more rapid impact on ovulation and hirsutism, while take more time on Hyperandrogenism. Meanwhile, local treatments can psychologically help the patient.

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Filiberto Di Prospero
Medical Doctor, Consultant in Gynecology and Obstetrics, Endocrinology and Metabolism. Director of Gynecologic Endocrinology Unit at Civitanova Marche General Hospital (Italy). Private clinics in Civitanova Marche, Rome and Milan.

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