New Therapeutic Approaches in Obesity and Metabolic Syndrome Associated with Polycystic Ovary Syndrome

Abstract

Polycystic ovary syndrome (PCOS) is a pathophysiological disorder affecting reproductive and metabolic indices. PCOS is commonly associated with a high prevalence of insulin resistance and obesity; this association carries an increased risk of developing metabolic syndrome, type 2 diabetes mellitus (T2DM), and cardiovascular disease. Guidelines recommend lifestyle modification, metformin, hormonal contraceptives (HCs), and bariatric surgery as the main treatment options in obese patients with PCOS. Studies are being conducted to test the efficacy of existing treatment options as well as to discover new therapies. This review focuses on the most recent advances in this regard and highlights new hypotheses and emerging studies to give a picture of the latest therapeutic trends in the treatment of obese patients with PCOS. In this respect, much attention is given to the role of inositols, the mediators of insulin action. A deficiency of d-chiro-inositol containing inositol-phospho-glycans may be the basis of insulin resistance frequently seen in PCOS patients. Moreover, evidence suggests the use of statins in obese women with PCOS, but guidelines call for further research. Adiponectin, quercetin, vitamin D, and anti-obesity drugs have also been studied and seem to have a useful role in the treatment of obesity and metabolic syndrome in PCOS. Many trials have been conducted on the use of non-pharmacological therapies. Therapies including resveratrol, acupuncture, and berberine have favorable effects in overweight PCOS patients. However, more research is needed to reveal the clinical complexity of PCOS and develop more effective treatment options.

Polycystic ovary syndrome management: a review of the possible amazing role of berberine

“…Berberine, if associated with a healthy lifestyle, improves women's body composition and causes androgen's reduction as pointed out by Saleem et al [3,8].…”

“…Berberine is also shown to be effective against insulin resistance and obesity, particularly against visceral adipose tissue in vitro and in murine models [2,7,8].…”

Patterns of Bariatric Surgeries Among U.S. Women Diagnosed with Polycystic Ovarian Syndrome

“…3,11,12 Pharmacological treatments address various aspects of PCOS, including insulin resistance (e.g., metformin and pioglitazone), menstrual abnormalities, hirsutism, and acne (e.g., hormonal contraceptives), endocrine-metabolic disorders (e.g., inositols), and obesity (e.g., orlistat), among others. 13 Presently available obesity drugs have raised safety concerns due to unknown teratogenic effects among reproductive-age women. 10 In contrast, current evidence supports bariatric surgery as more effective than nonsurgical treatments at achieving sustained weight loss, while mitigating obesity-related health problems, including type 2 diabetes, hypertension, dyslipidemia, metabolic syndrome, sleep apnea, and osteoarthritis.…”

Use of Acupuncture in Overweight/Obese Women with Polycystic Ovary Syndrome

“…For patients with PCOS, lifestyle modification, medication, and weight-loss surgery are also the main medical therapies in managing overweight/obesity and preventing metabolic comorbidities. 9 Yet, sustained, significant weight loss is difficult to achieve with these interventions or is frequently complicated by significant side-effects. Thus, development of a safe and effective body weight-control strategy is an important medical need for patients with PCOS.…”

“…The use of acupuncture for overweight/obese individuals with PCOS has been a long-standing practice in Chinese medicine, and a systematic review suggested that acupuncture has favorable effects in overweight patients who have PCOS. 9 In a 2016 trial of 17 overweight women with PCOS, 5 weeks of electroacupuncture (EA) treatment improved glucose regulation and adipose tissue androgens. 10 In contrast to exercise, EA improved insulin sensitivity and modulated adipose tissue gene expression without influencing adipose tissue in a rat PCOS model.…”