Features of treatment of polycystic ovary syndrome on the overweight background

І. М. Капшук

Abstract


The main strategic goal of treatment of polycystic ovary syndrome (PCOS) is not only restore fertility and achieve a cosmetic effect, but also the prevention of metabolic disorders later.

Lifestyle modifications with the inclusion of physical activity and a balanced diet are reasonable pathogenetic components of therapy and prevention of long-term effects of PCOS.

Well pronounced antiandrogenic effect in the treatment of PCOS has a selective androgen receptor inhibitor flutamide. However, in women with PCOS often develop nonalcoholic steatosis, particularly against the background of obesity, which limits the long-term use of this drug, as it is hepatotoxic effects. Given this, it is advisable to give preference to phyto- antiandrogens, one of which is normocycle. Advantages of drugs in this group have low toxicity and the possibility of long-term use without risk of serious adverse reactions.

The aim of the study was to improve the treatment of women with PCOS and excess body weight. We examined 105 women with a diagnosis of “polycystic ovary syndrome” in the background of excessive body weight and obesity aged 18 to 35 who were divided into two groups: group I consisted of 65 women who received developed treatment; II group – 40 women who received standard treatment. In the first phase (3 months) in both groups used the standard treatment: flutamide administered in the case of hyperandrogenism and in the case of insulin resistance – metformin. Patients of group I additionally used normocycle for 3 months and tivortin for 10 days. The next three months the women in both groups received advice on diet and exercises, and the patient group I continued to use normocycle for 3 months and tivortin for 14 days.

The results showed that the use of herbal anti-androgen (normocycle) and antihypoxant (tivortin) in the complex treatment of women with PCOS against the backdrop of excess body weight leads to permanent reduction of clinical symptoms and improve hormonal parameters.


Keywords


polycystic ovary syndrome; excess body weight; antiandrogens; antihypoxants

References


Tatarchuk, T.F. “Innovative approaches in obstetrics, gynecology and reproduction.” Medical Aspects of Women's Health, 10(86) (2014): 68–69.

Khaidarova, F.A. “The prevalence of polycystic ovary syndrome in women of childbearing age.” International Journal of Endocrinology, 3(2009): 82–84.

Pal, L. Polycystic ovary syndrome. Current and emerging concepts. New York. Springer Science & Business Media (2014): 340 p.

Nazarenko, T.A. Polycystic ovary syndrome: modern approaches to diagnosis and treatment of infertility. Moscow. MEDpress-Inform (2005): 208 p.

Naumenko, V.G. “Hyperandrogen states.” Medical Aspects of Women's Health, 1(2011): 5–10.

Grishchenko, V.I., et al. “Polycystic Ovary Syndrome as a cause of endocrine infertility.” The Medical Aspects of Women's Health, 1(2010): 5–13.

Douchi, T., Ijuin, H., Nakamura, S., et al. “Body fat distribution in women with polycystic ovary syndrome.” Obstet Gynecol, 86(1995): 516–519.

Al-Azemi, M., Omu, F.E., Omu, A.E. “The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome.” Archives of gynecology and obstetrics, 270(2004): 205–210.

Domecq, J.P., Prusky, G., Mullan, R.J., et al. “Adverse effects of common treatments for polycystic ovary syndrome: a systematic review and meta-analysis.” J Clin Endocrinol Metab, 98(12) (2013): 4646-4654.

Stamets, K.D., Taylor, S., Kunselman, A., et al. “A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome.” Fertil Steril, 81(2004): 630–637.

Kandarakis, D.E., Christakou, C.D., Kandaraki, E., et al. “Metformin: an old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome.” European Journal of Endocrinology, 162(2010): 193–212.

Legro, R.S., Arslanian, S.A., et al. “Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.” J Clin Endocrinol Metab, 98(12) (2013): 4565-4592.

Baillargeon, J.P., McClish, D.K., Essah, P.A., et al. “Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a metaanalysis.” Journal of Clinical Endocrinology and Metabolism, 90(2005): 3863–3870.

Lopez, L.M. “Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus.” Cochrane Database Syst Rev, 4(2009): 108–116.

Harmanci, A., Cinar, N., Bayraktar, M., et al. “Oral contraceptive plus antiandrogen therapy and cardiometabolic risk in polycystic ovary syndrome.” Clinical Endocrinology, 78(2013): 120–125.

Cagnacci, A., Piacenti, I., Zanini, R., et al. “Insulin sensitivity and lipid metabolism with oral contraceptives containing chlormadinone acetate or desogestrel.” Contraception, 79(2009): 111–116.

Rautio, K. “Effects of metformin and ethinyl estradiol-cyproterone acetate on lipid levels in obese and non-obese women with polycystic ovary syndrome.” Eur J Endocrinol, 152(2005): 269–275.

Bird, S.T., Hartzema, A.G., Brophy, J.M., et al. “Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis.” Canadian Medical Association Journal, 185(2013): 115–120.

Lidegaard, О., Nielsen, L.H., Skovlund, C.W., et al. “Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses.” Danish cohort study, 343(2001): 6423.

Pasquali, R., Gambineri, A. “Therapy in endocrine disease: treatment of hirsutism in the polycystic ovary syndrome.” European Journal of Endocrinology, 170(2013): 75–90.

Kelley, C.E., Brown, A.J., Diehl, A.M., Setji, T.L. “Review of nonalcoholic fatty liver disease in women with polycystic ovary syndrome.” World J Gastroenterol, 20(39) (2014): 14172–14184.

Rajandeep Kaur, Harpreet Kaur, Ajaib Singh Dhindsa. “Glycyrrhiza glabra: a phytopharmacological review.” IJPSR, 4(7) (2013): 2470–2477.

Vidyasagar, G.M., Murthy, S.M. “Siddalinga Ethnomedicinal plants used to treat menstrual disorders by tribal people in Bellary district of Karnataka.” India IJPLS, 3(2012): 1871–1876.

Muhammad Abdullah Shah, Syed Muhammad Abdullah, Muhammad Azim Khan, et al. “Ethnopharmacological of curcuma longa: a review.” IJPSR, 4(1) (2013): 103–112.

Tatarchuk, T.F., Kosei, N.V., Kapshuk, I.N., Vetokh, G.V. “Evaluation of the pelvic blood flow in women with polycystic ovary syndrome on the background of inflammatory pelvic processes.” Reproductive Health in Eastern Europe, 5(41) (2015): 15–23.

Tatarchuk, T.F., Voronenko, N.Y., Kapshuk, I.M. “State of adipose tissue at polycystic ovary syndrome.” Bulletin of Scientific Researches, 4(2013): 53–56.

Tatarchuk, T.F., Hanzhiy, I.Y., Pedachenko, N.Y., Kapshuk, I.M. “Modern possibilities of non-hormonal treatment of polycystic ovary syndrome in women with obesity.” Reproductive Endocrinology, 5(13) (2013): 14–21.

Villa, J., Pratley, R. “Adipose tissue dysfunction in polycystic ovary syndrome.” Current Diabetes Reports, 11(2011): 179–184.

Repaci, A., Gambineri, A., Pasquali, R. “The role of low-grade inflammation in the polycystic ovary syndrome.” Molecular and Cellular Endocrinology, 15(2011): 30–41.


GOST Style Citations


1. Татарчук, Т. Ф. Инновационные подходы в акушерстве, гинекологии и репродуктологии / Т.Ф. Татарчук // Медицинские аспекты здоровья женщины. — 2014. — № 10 (86). — С. 68–69.

2. Хайдарова, Ф.А. Распространенность синдрома поликистозных яичников среди женщин фертильного возраста / Ф.А. Хайдарова // Міжнародний ендокринологічний журнал. — 2009. — № 3. — С. 82–84.

3. Pal, L. Polycystic ovary syndrome. Current and emerging concepts. New York. Springer Science & Business Media (2014): 340 p.

4. Назаренко, Т.А. Синдром поликистозных яичников: современные подходы к диагностике и лечению бесплодия. — М.: МЕДпресс- информ. — 2005. — 208 с.

5. Науменко, В.Г. Гиперандрогенные состояния / В.Г. Науменко // Медицинские аспекты здоровья женщины. — 2011. — № 1. — С. 5–10.

6. Грищенко, В.И. Синдром поликистозных яичников как причина эндокринного бесплодия / В.И. Грищенко и др. // Медицинские аспекты здоровья женщины. — 2010. — № 1. — С. 5–13.

7. Douchi, T., Ijuin, H., Nakamura, S., et al. “Body fat distribution in women with polycystic ovary syndrome.” Obstet Gynecol, 86(1995): 516–519.

8. Al-Azemi, M., Omu, F.E., Omu, A.E. “The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome.” Archives of gynecology and obstetrics, 270(2004): 205–210.

9. Domecq, J.P., Prusky, G., Mullan, R.J., et al. “Adverse effects of common treatments for polycystic ovary syndrome: a systematic review and meta-analysis.” J Clin Endocrinol Metab, 98(12) (2013): 4646-4654.

10. Stamets, K.D., Taylor, S., Kunselman, A., et al. “A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome.” Fertil Steril, 81(2004): 630–637.

11. Kandarakis, D.E., Christakou, C.D., Kandaraki, E., et al. “Metformin: an old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome.” European Journal of Endocrinology, 162(2010): 193–212.

12. Legro, R.S., Arslanian, S.A., et al. “Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.” J Clin Endocrinol Metab, 98(12) (2013): 4565-4592.

13. Baillargeon, J.P., McClish, D.K., Essah, P.A., et al. “Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a metaanalysis.” Journal of Clinical Endocrinology and Metabolism, 90(2005): 3863–3870.

14. Lopez, L.M. “Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus.” Cochrane Database Syst Rev, 4(2009): 108–116.

15. Harmanci, A., Cinar, N., Bayraktar, M., et al. “Oral contraceptive plus antiandrogen therapy and cardiometabolic risk in polycystic ovary syndrome.” Clinical Endocrinology, 78(2013): 120–125.

16. Cagnacci, A., Piacenti, I., Zanini, R., et al. “Insulin sensitivity and lipid metabolism with oral contraceptives containing chlormadinone acetate or desogestrel.” Contraception, 79(2009): 111–116.

17 Rautio, K. “Effects of metformin and ethinyl estradiol-cyproterone acetate on lipid levels in obese and non-obese women with polycystic ovary syndrome.” Eur J Endocrinol, 152(2005): 269–275.

18. Bird, S.T., Hartzema, A.G., Brophy, J.M., et al. “Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis.” Canadian Medical Association Journal, 185(2013): 115–120.

19. Lidegaard, О., Nielsen, L.H., Skovlund, C.W., et al. “Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses.” Danish cohort study, 343(2001): 6423.

20. Pasquali, R., Gambineri, A. “Therapy in endocrine disease: treatment of hirsutism in the polycystic ovary syndrome.” European Journal of Endocrinology, 170(2013): 75–90.

21. Kelley, C.E., Brown, A.J., Diehl, A.M., Setji, T.L. “Review of nonalcoholic fatty liver disease in women with polycystic ovary syndrome.” World J Gastroenterol, 20(39) (2014): 14172–14184.

22. Rajandeep Kaur, Harpreet Kaur, Ajaib Singh Dhindsa. “Glycyrrhiza glabra: a phytopharmacological review.” IJPSR, 4(7) (2013): 2470–2477.

23. Vidyasagar, G.M., Murthy, S.M. “Siddalinga Ethnomedicinal plants used to treat menstrual disorders by tribal people in Bellary district of Karnataka.” India IJPLS, 3(2012): 1871–1876.

24. Muhammad Abdullah Shah, Syed Muhammad Abdullah, Muhammad Azim Khan, et al. “Ethnopharmacological of curcuma longa: a review.” IJPSR, 4(1) (2013): 103–112.

25. Татарчук, Т.Ф. Оценка тазового кровотока у женщин с синдромом поликистозных яичников на фоне воспалительных процессов органов малого таза / Т.Ф. Татарчук, Н.В. Косей, И.Н. Капшук, Г.В. Ветох // Репродуктивное здоровье Восточная Европа. — 2015. — № 5 (41). — С. 15–23.

26. Татарчук, Т.Ф. Стан жирової тканини при синдромі полікістозних яєчників / Т.Ф. Татарчук, Н.Ю. Вороненко, І.М. Капшук // Вісник наукових досліджень. — 2013. — № 4. — С. 53–56.

27. Татарчук, Т.Ф. Сучасні можливості негормонального лікування синдрому полікістозних яєчників у жінок із ожирінням / Т.Ф. Татарчук, І.Ю. Ганжий, Н.Ю. Педаченко, І.М. Капшук // Репродуктивна ендокринологія. — 2013. — № 5 (13). — С. 14–21.

28. Villa, J., Pratley, R. “Adipose tissue dysfunction in polycystic ovary syndrome.” Current Diabetes Reports, 11(2011): 179–184.

29. Repaci, A., Gambineri, A., Pasquali, R. “The role of low-grade inflammation in the polycystic ovary syndrome.” Molecular and Cellular Endocrinology, 15(2011): 30–41.





DOI: http://dx.doi.org/10.18370/2309-4117.2015.25.21-26

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)