Pharmacological and surgical treatment of nonreproductive outcomes in polycystic ovary syndrome: An overview of systematic reviews

Tay, Chau Thien; Joham, Anju E.; Hiam, Danielle; Gadalla, Moustafa Abdelhafez; Pundir, Jyotsna; Thangaratinam, Shakila; Teede, Helena; Moran, Lisa J.

doi:10.1111/cen.13753

Cited by 18 publications

(25 citation statements)

References 78 publications

(577 reference statements)

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“…53 Previous studies have raised concerns of COCPs affecting insulin resistance and triglycerides; however, a recent overview of systematic reviews found no evidence of increased cardiovascular events in prolonged use of COCPs. 54 There is limited information on which COCP preparation type or duration of therapy is optimal for women with PCOS, with all agents reducing SHBG and improving clinical outcomes. Therefore, to minimize complications and based on general population data, recommendations are to use the lowest effective estrogen dose and natural estrogen preparations, balancing efficacy, metabolic risk profile, side effects, costs, and availability.…”

Section: Treatment Of Nonreproductive Outcomesmentioning

confidence: 99%

A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines

et al. 2018

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Polycystic ovary syndrome (PCOS) is a common hormonal condition with reproductive, metabolic, and psychological sequelae. The Rotterdam Criteria are now internationally accepted, with different phenotypes recognized with varying clinical presentations and risk profiles. The complexity of the disorder, and the impact on quality of life, requires timely diagnosis, screening for complications and management strategies. PCOS remains underdiagnosed and women experience significant delays to diagnosis. Effective dissemination of evidence-based management is therefore vital. In this review, we summarize key aspects of PCOS as a prelude to this issue of on PCOS which focuses on the development of the international evidence-based guideline on the assessment and management of PCOS and the related translation program. We cover diagnostic criteria, prevalence, phenotypes, reproductive, metabolic, and psychological factors of PCOS. We also cover management strategies including lifestyle interventions as well as treatment of nonreproductive outcomes and reproductive outcomes informed by the latest international evidence-based guidelines.

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Section: Treatment Of Nonreproductive Outcomesmentioning

confidence: 99%

A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines

et al. 2018

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“…However, in order to reduce the thromboembolic risk, the lowest effective estrogen doses (such as 20–30 μg of ethinylestradiol) or the use of natural estradiol should be preferred. Even though clinical trials ( 127 ) almost always use COCPs containing antiandrogen progestins (due to higher effect on hyperandrogenism symptoms), the guidelines do not recommend a specific progestin. A recent meta-analysis showed that COCPs containing cyproterone acetate are more effective in suppressing gonadotropins, leading to a decrease in androgen levels ( 128 ).…”

Section: Introductionmentioning

confidence: 99%

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

et al. 2020

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Polycystic ovary syndrome (PCOS) is a very common endocrine and metabolic disorder with the involvement of both genetic and environmental factors. Although much has been clarified on its pathogenesis, diagnosis, clinical manifestations, and therapy, there are still areas of uncertainty. To address fundamental concepts, novel aspects and hypotheses, and future perspectives, including the possible additional benefits of treatment with nutraceuticals, an expert consensus panel formed by endocrinologists and gynecologists was established. After an independent review of the literature, the panel convened electronically on February 3, 2020, and six resolutions were created, debated, and agreed upon discussion, and finally approved in their final form in a consensus livestream meeting held on April 15. The summary of the resolutions are: (1) PCOS is a well-established medical condition that negatively affects reproduction, general health, sexual health, and quality of life; (2) the symptoms and signs of PCOS appear early in life especially in female newborns from PCOS carriers; (3) women with PCOS have significantly increased risk of pregnancy-related complications including gestational diabetes mellitus; (4) a male PCOS equivalent exists, and it may impact on metabolic health and probably on reproduction; (5) the evidence supports that medical therapy for PCOS is effective, rational, and evidence-based; (6) the evidence supports a major research initiative to explore possible benefits of nutraceutical therapy for PCOS. The proposed resolutions may be regarded as points of agreement based on the current scientific evidence available.

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“…Briefly, the population was women with PCOS, and the intervention was a systematic review with or without a meta-analysis with a primary focus on genetic associations. Systematic reviews not on the genetics of PCOS (e.g., focusing on assessment or treatment) were excluded and are the focus of separate OSRs [28,29]. The specific inclusion criteria for systematic reviews were a publication date from 2009 onwards, description of a search strategy containing at least key words or terms, inclusion of the number of identified and included articles, and quality appraisal of the articles.…”

Section: Methodsmentioning

confidence: 99%

The Genetics of Polycystic Ovary Syndrome: An Overview of Candidate Gene Systematic Reviews and Genome-Wide Association Studies

Hiam

Moreno-Asso

Teede

et al. 2019

JCM

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Polycystic Ovary Syndrome (PCOS) is a complex condition with mechanisms likely to involve the interaction between genetics and lifestyle. Familial clustering of PCOS symptoms is well documented, providing evidence for a genetic contribution to the condition. This overview aims firstly to systematically summarise the current literature surrounding genetics and PCOS, and secondly, to assess the methodological quality of current systematic reviews and identify limitations. Four databases were searched to identify candidate gene systematic reviews, and quality was assessed with the AMSTAR tool. Genome-wide association studies (GWAS) were identified by a semi structured literature search. Of the candidate gene systematic reviews, 17 were of high to moderate quality and four were of low quality. A total of 19 gene loci have been associated with risk of PCOS in GWAS, and 11 of these have been replicated across two different ancestries. Gene loci were located in the neuroendocrine, metabolic, and reproductive pathways. Overall, the gene loci with the most robust findings were THADA, FSHR, INS-VNTR, and DENND1A, that now require validation. This overview also identified limitations of the current literature and important methodological considerations for future genetic studies. Much work remains to identify causal variants and functional relevance of genes associated with PCOS.

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Pharmacological and surgical treatment of nonreproductive outcomes in polycystic ovary syndrome: An overview of systematic reviews

Cited by 18 publications

References 78 publications

A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines

A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

The Genetics of Polycystic Ovary Syndrome: An Overview of Candidate Gene Systematic Reviews and Genome-Wide Association Studies

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