Polycystic ovary syndrome

被引:440
作者
Joham, Anju E. [1 ,2 ]
Norman, Robert J. [3 ]
Stener-Victorin, Elisabet [4 ]
Legro, Richard S. [5 ]
Franks, Stephen [6 ]
Moran, Lisa J. [1 ]
Boyle, Jacqueline [1 ]
Teede, Helena J. [1 ,2 ]
机构
[1] Monash Univ, Sch Publ Hlth & Prevent Med, Monash Ctr Hlth Res & Implementat, Melbourne, Vic, Australia
[2] Monash Hlth, Dept Endocrinol & Diabet, Melbourne, Vic, Australia
[3] Univ Adelaide, Robinson Res Inst, Adelaide, SA, Australia
[4] Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden
[5] Penn State Univ, Coll Med, Dept Obstet & Gynecol, Hershey, PA USA
[6] Imperial Coll London, Reprod & Dev Biol, London, England
基金
英国医学研究理事会;
关键词
DIAGNOSTIC-CRITERIA; PREGNANCY OUTCOMES; INSULIN-RESISTANCE; ANDROGEN EXCESS; INFERTILE WOMEN; PREVALENCE; OBESITY; RISK; PCOS; HYPERANDROGENEMIA;
D O I
10.1016/S2213-8587(22)00163-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Polycystic ovary syndrome (PCOS) affects 5-18% of women, and is a reproductive, metabolic, and psychological condition with impacts across the lifespan. The cause is complex, and includes genetic and epigenetic susceptibility, hypothalamic and ovarian dysfunction, excess androgen exposure, insulin resistance, and adiposity-related mechanisms. Diagnosis is recommended based on the 2003 Rotterdam criteria and confirmed with two of three criteria: hyperandrogenism (clinical or biochemical), irregular cycles, and polycystic ovary morphology. In adolescents, both the criteria of hyperandrogenism and irregular cycles are needed, and ovarian morphology is not included due to poor specificity. The diagnostic criteria generates four phenotypes, and clinical features are heterogeneous, with manifestations typically arising in childhood and then evolving across adolescent and adult life. Treatment involves a combination of lifestyle alterations and medical management. Lifestyle optimisation includes a healthy balanced diet and regular exercise to prevent excess weight gain, limit PCOS complications and target weight reduction when needed. Medical management options include metformin to improve insulin resistance and metabolic features, combined oral contraceptive pill for menstrual cycle regulation and hyperandrogenism, and if needed, anti-androgens for refractory hyperandrogenism. In this Review, we provide an update on the pathophysiology, diagnosis, and clinical features of PCOS, and discuss the needs and priorities of those with PCOS, including lifestyle, and medical and infertility treatment. Further we discuss the status of international evidence-based guidelines (EBG) and translation, to support patient self management, healthcare provision, and to set research priorities.
引用
收藏
页码:668 / 680
页数:13
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