Ajossa S, Guerriero S, Paoletti A M, Orrù M, Melis G B
Section of Gynecology and Obstetrics and of Human Reproduction Fisiology, Department of Maternal-Infantile Surgery and Imaging Sciences, University of Cagliari, Cagliari, Italy.
Minerva Ginecol. 2004 Feb;56(1):15-26.
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women in reproductive age. As for the treatment of this disease the lack of a clear etiology for PCOS has led to a symptom-orientated treatment. However, the overall aims of treatment are to induce ovulation for women desiring conception, to reduce androgen levels, to reduce body weight and to reduce long-term health risks of diabetes mellitus and cardiovascular disease. Clomiphene citrate (CC) is recommended as first line treatment for induction of ovulation in patients with PCOS by virtue of its efficacy, safety, and ease of administration. Alternatives for CC-resistant patients include gonadotrophin therapy (better with low-dose step-up protocol) and laparoscopic ovarian diathermy. Recently, recombinant FSH (rFSH) has been introduced in clinical practice and it seems more effective than urinary FSH as demonstrated by a significantly higher number of follicles recruited and embryos obtained with a shorter treatment period. The addition of GnRH-agonist to the stimulation protocol for women affected by PCOS could reduce premature luteinization and increase cycle fecundity. Other drugs under investigation are metformin and cabergoline. Hirsutism is the manifestation of hyperandrogenemia in PCOS. The primary goal of the treatment of hirsutim is central or peripheral androgen suppression using 3 groups of drugs: inhibitors of androgen production (oral contraceptives, GnRH analogues), peripheral androgen blockers (cyproterone acetate, flutamide, finasteride and spironolactone), and insulin-sensitizing agents (metformin). Weight reduction and exercise could also improve not only menstrual disturbances and infertility, but also insulin resistance and its adverse metabolic con-sequences.
多囊卵巢综合征（PCOS）是育龄期女性最常见的内分泌疾病之一。至于该疾病的治疗，由于PCOS病因尚不明确，导致其治疗以症状为导向。然而，治疗的总体目标是为有受孕意愿的女性诱导排卵、降低雄激素水平、减轻体重以及降低糖尿病和心血管疾病的长期健康风险。枸橼酸氯米芬（CC）因其疗效、安全性和给药便利性，被推荐作为PCOS患者诱导排卵的一线治疗药物。对于CC抵抗的患者，替代方案包括促性腺激素治疗（低剂量逐步递增方案更佳）和腹腔镜卵巢打孔术。最近，重组促卵泡生成素（rFSH）已应用于临床实践，且似乎比尿促卵泡生成素更有效，表现为募集的卵泡数量显著增多、获得的胚胎数量增多且治疗周期更短。对于PCOS女性，在刺激方案中添加促性腺激素释放激素（GnRH）激动剂可减少过早黄素化并提高周期受孕率。正在研究的其他药物有二甲双胍和卡麦角林。多毛症是PCOS中高雄激素血症的表现。治疗多毛症的主要目标是使用三类药物抑制中枢或外周雄激素：雄激素生成抑制剂（口服避孕药、GnRH类似物）、外周雄激素阻滞剂（醋酸环丙孕酮、氟他胺、非那雄胺和螺内酯）以及胰岛素增敏剂（二甲双胍）。减轻体重和运动不仅可以改善月经紊乱和不孕，还可以改善胰岛素抵抗及其不良代谢后果。
