DISMOT Department, University of Palermo, Palermo, Italy.
J Endocrinol Invest. 2013 May;36(5):358-63. doi: 10.3275/8882. Epub 2013 Feb 27.
Because women affected by polycystic ovary syndrome (PCOS) present an increased cardiovascular risk, the safety of estroprogestin treatment is debated and contrasting data have been reported. However, cardiovascular risk is not the same in all PCOS women and individual cardiovascular risk should be assessed before staring any estroprogestin treatment. The available data show that products containing both 2nd-generation and 3rd-generation progestins (including drospirenone and cyproterone acetate) represent a safe treatment in PCOS patients with regular cardiovascular risk. In PCOS patients with increased cardiovascular risk, a careful choice of estroprogestin product is needed and cardiovascular risk should be monitored during treatment. In obese PCOS patients with normal glucose tolerance and lipid profile, products containing 2nd-generation progestins may be preferred because of lower venous thromboembolism risk. In PCOS patients with altered lipid profile or glucose intolerance, 3rd-generation progestins should be used but, during treatment, cardiovascular risk should be periodically re-assessed. In special situations, metformin or statins may be added to estroprogestin treatment.
由于多囊卵巢综合征（PCOS）患者存在心血管风险增加，因此雌激素孕激素治疗的安全性存在争议，并且已有相互矛盾的数据报道。然而，并非所有 PCOS 女性的心血管风险都相同，在开始任何雌激素孕激素治疗之前，都应评估个体的心血管风险。现有数据表明，含有第二代和第三代孕激素（包括屈螺酮和醋酸环丙孕酮）的产品在具有常规心血管风险的 PCOS 患者中代表一种安全的治疗方法。在心血管风险增加的 PCOS 患者中，需要仔细选择雌激素孕激素产品，并且在治疗期间应监测心血管风险。在糖耐量和血脂谱正常的肥胖 PCOS 患者中，由于静脉血栓栓塞风险较低，可能更倾向于使用含有第二代孕激素的产品。在血脂谱或糖耐量异常的 PCOS 患者中，应使用第三代孕激素，但在治疗过程中，应定期重新评估心血管风险。在特殊情况下，可能需要将二甲双胍或他汀类药物添加到雌激素孕激素治疗中。
