PCOS: phenotypes, visceral obesity and a personalized approach in the prescription of COC

Abstract

Polycystic ovary syndrome (PCOS) is a complex of endocrine disease with several phenotypes, which determines the difficulties in its diagnostics (“diagnosis of exceptions”). This is an interdisciplinary disease, as the consequences of this syndrome can be serious (infertility, cardiovascular diseases, diabetes mellitus and their complications). The reason for this is the fact that PCOS occurs with metabolic disorders, manifested as violations of carbohydrate and fat metabolism.Determination of specific phenotypes of women with PCOS are justified from the point of metabolism. Metabolic disorders in PCOS can prevail throughout life. At the initial stages, these changes may be invisible and not diagnosed. PCOS is often characterized by the presence of insulin resistance and is associated with hyperinsulinemia in most obese patients.PCOS can occur with various forms of obesity, the most important is visceral obesity. This connected with the fact that visceral obesity may present in women with PCOS with no elevated body mass index. Therefore, timely diagnostics of obesity, especially visceral, determines the health consequences of this syndrome.There are certain difficulties in the diagnostics of visceral obesity, but many of them are surmountable in modern conditions. Women with PCOS need the use combined oral contraceptives with both contraceptive and curative purposes. Therefore, the choice of the medicine depending on the clinical situation, the peculiarities of redistribution of adipose tissue is important in clinical practice. With the correct choice of COC, there will be no significant adverse effects on the metabolic profile of patients with PCOS and, possibly, a positive effect on their lipid profile will be observed. And yet, weight loss can lead to spontaneous ovulation in women with PCOS and overweight or obese, so the first choice in treatment of such patients should be diet and lifestyle changes, including an increase of daily physical activity.