Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano of Reggio Calabria, Reggio Calabria, Italy.
Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland.
Hum Reprod Update. 2021 Apr 21;27(3):584-618. doi: 10.1093/humupd/dmaa051.
Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. An endometrial component has been suggested to contribute to subfertility and poor reproductive outcomes in affected women.
The aim of this review was to determine whether there is sufficient evidence to support that endometrial function is altered in women with PCOS, whether clinical features of PCOS affect the endometrium, and whether there are evidence-based interventions to improve endometrial dysfunction in PCOS women.
An extensive literature search was performed from 1970 up to July 2020 using PubMed and Web of Science without language restriction. The search included all titles and abstracts assessing a relationship between PCOS and endometrial function, the role played by clinical and biochemical/hormonal factors related to PCOS and endometrial function, and the potential interventions aimed to improve endometrial function in women with PCOS. All published papers were included if considered relevant. Studies having a specific topic/hypothesis regarding endometrial cancer/hyperplasia in women with PCOS were excluded from the analysis.
Experimental and clinical data suggest that the endometrium differs in women with PCOS when compared to healthy controls. Clinical characteristics related to the syndrome, alone and/or in combination, may contribute to dysregulation of endometrial expression of sex hormone receptors and co-receptors, increase endometrial insulin-resistance with impaired glucose transport and utilization, and result in chronic low-grade inflammation, immune dysfunction, altered uterine vascularity, abnormal endometrial gene expression and cellular abnormalities in women with PCOS. Among several interventions to improve endometrial function in women with PCOS, to date, only lifestyle modification, metformin and bariatric surgery have the highest scientific evidence for clinical benefit.
Endometrial dysfunction and abnormal trophoblast invasion and placentation in PCOS women can predispose to miscarriage and pregnancy complications. Thus, patients and their health care providers should advise about these risks. Although currently no intervention can be universally recommended to reverse endometrial dysfunction in PCOS women, lifestyle modifications and metformin may improve underlying endometrial dysfunction and pregnancy outcomes in obese and/or insulin resistant patients. Bariatric surgery has shown its efficacy in severely obese PCOS patients, but a careful evaluation of the benefit/risk ratio is warranted. Large scale randomized controlled clinical trials should address these possibilities.
多囊卵巢综合征（PCOS）是无排卵性不孕的最常见原因。有人提出，子宫内膜成分可能导致受影响女性的生育力下降和生殖结局不佳。
本综述的目的是确定是否有足够的证据支持 PCOS 妇女的子宫内膜功能发生改变，PCOS 的临床特征是否影响子宫内膜，以及是否有循证干预措施可以改善 PCOS 妇女的子宫内膜功能障碍。
从 1970 年到 2020 年 7 月，使用 PubMed 和 Web of Science 进行了广泛的文献检索，没有语言限制。检索包括评估 PCOS 与子宫内膜功能之间关系的所有标题和摘要、与 PCOS 和子宫内膜功能相关的临床和生化/激素因素的作用，以及旨在改善 PCOS 妇女子宫内膜功能的潜在干预措施。如果认为相关，则纳入所有已发表的论文。从分析中排除了专门针对患有 PCOS 的妇女的子宫内膜癌/增生的特定主题/假设的研究。
实验和临床数据表明，与健康对照组相比，患有 PCOS 的妇女的子宫内膜存在差异。与该综合征相关的临床特征，单独或联合，可能导致性激素受体和共受体的子宫内膜表达失调、增加子宫内膜胰岛素抵抗和葡萄糖转运及利用受损，导致慢性低度炎症、免疫功能障碍、改变子宫血管、PCOS 妇女中异常的子宫内膜基因表达和细胞异常。在改善 PCOS 妇女子宫内膜功能的几种干预措施中，迄今为止，只有生活方式改变、二甲双胍和减肥手术具有最高的科学证据表明具有临床益处。
PCOS 妇女的子宫内膜功能障碍和异常滋养层侵入和胎盘形成可能导致流产和妊娠并发症。因此，患者及其医疗保健提供者应该就这些风险进行咨询。尽管目前尚无干预措施可以普遍用于逆转 PCOS 妇女的子宫内膜功能障碍，但生活方式改变和二甲双胍可能会改善肥胖和/或胰岛素抵抗患者的潜在子宫内膜功能障碍和妊娠结局。减肥手术已显示出对严重肥胖的 PCOS 患者的疗效，但需要仔细评估其利弊。大规模随机对照临床试验应解决这些可能性。
