Effectiveness of a differentiated approach to the treatment of patients with polycystic ovary syndrome using inositols and combined oral contraceptives in early reproductive age
Objective. To evaluate the effectiveness of treatment of girls aged 15–18 years with different phenotypes of polycystic ovary syndrome (PCOS) using combined oral contraceptives (COCs) and inositols depending on overweight and insulin resistance in girls. Materials and methods. The study included 153 patients aged 15–18 years with PCOS and 32 healthy controls; girls of the study group had oligo/amenorrhea, hyperandrogenism, and polycystic ovarian morphology revealed by the ultrasound assessment. The comparative analysis of clinical and anamnestic data of patients with PCOS (n=153) and the control group (n=32) was performed at the first stage of the study. Depending on the PCOS phenotype, overweight, and insulin resistance, there were groups of hormonal and non-hormonal management; the results of the clinical examination were compared before the administration of therapy and 6 months after it. The groups were compared with each other and with the control group; the results obtained after receiving the treatment were compared with the baseline values and with the group of healthy girls. Results. Before the therapy, the patients with PCOS showed a significant increase in the level of luteinizing hormone (LH), testosterone (T), androstenedione, anti-Müllerian hormone (AMH), and free androgen index (FIA) accompanied by low levels of sex hormone-binding globulin (SHBG) (p<0.0001 for all indicators) as well as significantly higher levels of 17-OHP, DHEA-S, and cortisol (p<0.005). Phenotypes B and D differed from phenotype A having higher levels of LH, T, androstenedione, and FIA (p<0.005 for all indicators). After the therapy with combined oral contraceptives, patients with phenotype A showed a significant decrease in LH, T, FIA, DHEA-S, androstenedione (p<0.005 for all indicators) and ovarian volume (p<0.005), but it was necessary to continue administering therapy, as the main hormonal and ultrasound characteristics were not normalized. A half of the patients with phenotypes B and D who received non-hormonal treatment with inositols showed a clinical effect after 6 months; their menstrual cycle restored and the main hormonal parameters were normalized according to the levels of LH, T, FIA, and SHBG. As the result did not demonstrate statistical significance and normative values, it was necessary to continue administering the non-hormonal therapy. There was no clinical effect of non-hormonal therapy in 13.6% of patients with PCOS, therefore, the therapy was changed. Conclusion. The administration of microdosed COCs with drospirenone for 6 months demonstrated its clinical effectiveness in the treatment of teenagers with classic PCOS, however, this period of administration was not sufficient for the clinical effect. It is recommended to continue the treatment of PCOS with COCs in teenagers for more than 6 months, and assess the hormonal parameters and the degree of hyperandrogenism before withdrawal of the drugs. The clinical effect was also observed in patients with non-classical PCOS after receiving non-hormonal combined therapy, namely the 5:1 ratio of myoinositol and D-chiroinositol. There was a tendency for normalization of hormonal and ultrasound parameters, which did not reach the standard values, so the therapy should be continued. However, the treatment had to be changed in 13% of the patients as they did not respond to the therapy.Khashchenko E.P., Nadzharyan A.G., Uvarova E.V.
Keywords
polycystic ovary syndrome
overweight
insulin resistance
hyperandrogenism
hyperglycemia
myo-inositol
D-chiroinositol
combined oral contraceptives
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Received 11.03.2021
Accepted 18.03.2021
About the Authors
Elena P. Khashchenko, PhD, senior researcher, 2nd Gynecological Department (children and adolescent gynecology), V.I. Kulakov National Medical Research Centerfor Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. Tel.: +7(495)438-85-42. Е-mail: khashchenko_elena@mail.ru. ORCID: 0000-0002-3195-307X.
117997, Russia, Moscow, Ac. Oparina str., 4.
Ani G. Nadzharyan, student of the Faculty of Fundamental Medicine, Lomonosov Moscow State University. E-mail: ani_nad@list.ru.
119991, Russia, Moscow, Leninskiye Gory, д. 1.
Elena V. Uvarova, Dr. Med. Sci., Professor, Head of the 2nd Gynecological Department (children and adolescent gynecology), V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; Professor of the Department of Obstetrics, Gynecology, Perinatology and Reproductology, Institute of Professional Education, Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University). E-mail: elena-uvarova@yandex.ru. ORCID: 0000-0002-3105-5640. 117997, Russia, Moscow, Ac. Oparina str., 4.
For citation: Khashchenko E.P., Nadzharyan A.G., Uvarova E.V. Effectiveness of a differentiated approach to the treatment of patients with polycystic ovary syndrome using inositols and combined oral contraceptives in early reproductive age.
Akusherstvo i Ginekologiya / Obstetrics and gynecology. 2021; 3: 154-166 (in Russian)
https://dx.doi.org/10.18565/aig.2021.3.154-166
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