Minerva ginecologica
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Minerva ginecologica · Feb 2004
Comparative StudyDiagnosis of polycystic ovary syndrome: from NIH criteria to ESHRE-ASRM guidelines.
In the past, the diagnosis of polycystic ovary syndrome (PCOS) was based on National Institute of Health (NIH) criteria (hyperandrogenism and chronic anovulation) or on sonographic findings of polycystic ovaries. Diffe-rences in diagnosis criteria made it difficult to compare the data of studies coming from different countries. Moreover, there was criticism of both the methods used. ⋯ These diagnostic guidelines represent important progress because they are more flexible and permit us to make the diagnosis in patients who were previously excluded by the syndrome (such as ovulatory hyperandrogenic women with polycystic ovaries or anovulatory normoandrogenic women with polycystic ovaries). However, doubts still exist and regard some borderline group of patients such as hirsute ovulatory normoandrogenic women with polycystic ovaries. A new classification of PCOS syndrome is suggested on the basis of new guidelines.
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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. ⋯ 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.