verezdoВестник репродуктивного здоровьяBulletin of Reproductive Health2075-65692310-421XEndocrinology Research Centre (Moscow)10.14341/brh12779verezdo-12779Research ArticleНАУЧНЫЙ ОБЗОРREVIEWМультидисциплинарный взгляд на синдром поликистоза яичников: синергия подходовA multidisciplinary approach to polycystic ovary syndrome: synergy of methodshttps://orcid.org/0000-0001-8425-0020АндрееваЕ. Н.AndreevaE. N.

Москва

Андреева Елена Николаевна - д.м.н., профессор.

117036, Москва, ул. Дм. Ульянова, д. 11

Elena N. Andreeva - MD, Doctor of Sciences, Professor.

11 Dm.Ulyanova street, 117036 Moscow

iceberg1995@mail.ruhttps://orcid.org/0000-0002-5634-7877МельниченкоГ. А.Mel’nichenkoG. A.

Мельниченко Галина Афанасьевна - д.м.н., профессор, академик РАН.

Москва

Galina A. Melnichenko - MD, PhD, Professor.

Moscow

teofrast2000@mail.ruhttps://orcid.org/0000-0002-6551-4147ЯрмолинскаяМ. И.YarmolinskayaM. I.

Ярмолинская Мария Игоревна - д.м.н.

Санкт-Петербург

Mariya I. Yarmolinskaya - MD, Doctor of Sciences, Professor.

Saint Petersburg

m.yarmolinskaya@gmail.comhttps://orcid.org/0000-0003-1663-5265ХамошинаМ. Б.KhamoshinaM. B.

Хамошина Марина Борисовна - д.м.н., профессор.

Москва

Marina B. Hamoshina - MD, Doctor of Sciences, Professor.

Moscow

khamoshina@mail.ruhttps://orcid.org/0000-0002-6271-7803СутуринаЛ. В.SuturinaL. V.

Сутурина Лариса Викторовна - д.м.н., профессор.

Москва

Larisa V. Suturina - MD, Doctor of Sciences, Professor.

Irkutsk

lsuturina@mail.ruhttps://orcid.org/0000-0001-9943-0964БурумкуловаФ. Ф.BurumkulovaF. F.

Бурумкулова Фатима Фархадовна - д.м.н., в.н.с.

Москва

Fatima F. Burumkulova - MD, PhD, leading research associate.

Moscow

fatima-burumkulova@yandex.ruhttps://orcid.org/0000-0003-4979-7420ГригорянО. Р.GrigoryanO. R.

Григорян Ольга Рафаэльевна - д.м.н., профессор.

Москва

Olga R. Grigoryan - MD, Doctor of Sciences, professor.

Moscow

iceberg1995@mail.ruhttps://orcid.org/0000-0002-3443-7206СухареваО. Ю.SukharevaO. Yu.

Сухарева Ольга Юрьевна - к.м.н., в.н.с.

Москва

Olga Y. Sukhareva - MD, PhD, leading researcher.

Moscow

olgasukhareva@mail.ruhttps://orcid.org/0000-0002-2512-833XТиселькоА. В.TiselkoA. V.

Тиселько Алена Викторовна - д.м.н.

Санкт-Петербург

Alena V. Tiselko - MD, MD, Doctor of Sciences.

Moscow

alenadoc@mail.ruhttps://orcid.org/0000-0001-7470-1676ВоротниковаС. Ю.VorotnikovaS. Yu.

Воротникова Светлана Юрьевна - к.м.н.

Москва

Svetlana Y. Vorotnikova – MD.

Moscow

bra_svetix@list.ruАрбатскаяН. Ю.ArbatskayaN. Yu.

Арбатская Наталья Юрьевна - к.м.н., доцент.

Москва

Natalia Y. Arbatskaya - MD, PhD, associate professor.

Moscow

info@pm-clinic.ruhttps://orcid.org/0000-0002-8175-7886ДедовИ. И.DedovI. I.

Дедов Иван Иванович - академик РАН, д.м.н., профессор.

Москва

Ivan I. Dedov - MD, PhD, Professor.

Moscow

dedov@endocrincentr.ruГНЦ РФ ФГБУ «Национальный медицинский исследовательский центр эндокринологии им. академика И.И. Дедова»; ФГБОУ ВО «Российский университет медицины» Минздрава РФРоссияNational Research Centre for Endocrinology of the Russian Ministry of Health; Russian University of MedicineRussian FederationГНЦ РФ ФГБУ «Национальный медицинский исследовательский центр эндокринологии им. академика И.И. Дедова»РоссияNational Research Centre for Endocrinology of the Russian Ministry of HealthRussian FederationФГБНУ «Научно-исследовательский институт акушерства, гинекологии и репродуктологии им. Д.О. Отта»; ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова»РоссияResearch Institute of Obstetrics and Gynecology named after D.O. Ott; North-Western State Medical University named after I.I. MechnikovRussian FederationФГАОУ ВО «Российский университет дружбы народов имени Патриса Лумумбы»РоссияRUDN UniversityRussian FederationФБГНУ «Научный центр проблем здоровья семьи и репродукции человека»РоссияScientific Center for Family Health and Human ReproductionRussian FederationГБУЗ МО «Московский областной НИИ акушерства и гинекологии им. академика В.И. Краснопольского»РоссияMoscow Regional Research Institute of Obstetrics and GynecologyRussian FederationФГБНУ «Научно-исследовательский институт акушерства, гинекологии и репродуктологии им. Д.О. Отта»РоссияResearch Institute of Obstetrics and Gynecology named after D.O. OttRussian FederationПМ КлиникРоссияPM ClinicRussian Federation202505112025435364Copyright © Андреева Е.Н., Мельниченко Г.А., Ярмолинская М.И., Хамошина М.Б., Сутурина Л.В., Бурумкулова Ф.Ф., Григорян О.Р., Сухарева О.Ю., Тиселько А.В., Воротникова С.Ю., Арбатская Н.Ю., Дедов И.И., 20252025Андреева Е.Н., Мельниченко Г.А., Ярмолинская М.И., Хамошина М.Б., Сутурина Л.В., Бурумкулова Ф.Ф., Григорян О.Р., Сухарева О.Ю., Тиселько А.В., Воротникова С.Ю., Арбатская Н.Ю., Дедов И.И.Andreeva E.N., Mel’nichenko G.A., Yarmolinskaya M.I., Khamoshina M.B., Suturina L.V., Burumkulova F.F., Grigoryan O.R., Sukhareva O.Y., Tiselko A.V., Vorotnikova S.Y., Arbatskaya N.Y., Dedov I.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vrz-endojournals.ru/jour/article/view/12779

Синдром поликистозных яичников (СПЯ) — одно из наиболее распространенных эндокринных заболеваний, которое является частой причиной бесплодия, овуляторной дисфункции и нарушений менструального цикла у женщин репродуктивного возраста, а также фактором риска развития нарушений углеводного обмена (НУО) и сердечно-сосудистых заболеваний (ССЗ). В зависимости от клинических проявлений, возраста и репродуктивных планов пациентки, цели и стратегии лечения СПЯ могут отличаться. В настоящее время накоплено достаточно данных о благоприятном влиянии терапии метформином на овуляторную функцию, регулярность менструального цикла, фертильность и исходы беременности у пациенток с СПЯ, связанным с его действием на инсулинорезистентность, гиперинсулинемию и гиперандрогению. У пациентов с СПЯ и НУО назначение метформина способствует не только улучшению гликемических показателей, но и оказывает ряд плейотропных эффектов, которые способствуют снижению риска прогрессирования углеводных нарушений, а также развития ССЗ.  При СПЯ дисфункция яичников способствует каскаду метаболических и сосудистых изменений даже в отсутствие сахарного диабета 2 типа (СД2), в связи с чем показания для назначения метформина в этой группе пациенток могут выходить за рамки лечения НУО.

В настоящей статье представлена резолюция совета экспертов по особенностям ведения взрослых пациенток с СПЯ с учетом современных знаний о репродуктивных, метаболических и сердечно-сосудистых рисках, а также обсуждены основные данные по использованию метформина у женщин с СПЯ в различных клинических ситуациях и юридические аспекты его назначения в современной клинической практике.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. PCOS is a leading cause of infertility, ovulatory dysfunction, menstrual irregularities and a well-known risk factor for prediabetes, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Depending on the clinical manifestations, patient’s age and reproductive life plans the goals and strategies of PCOS treatment may differ. There is currently clinical evidence of the positive effects of metformin on ovulatory function, menstrual cycle regularity, fertility and pregnancy outcomes in patients with PCOS. These results related to metformin’s effects on insulin resistance, hyperinsulinemia and hyperandrogenism. In patients with PCOS and prediabetes or T2DM metformin improves glycemic control and also exerts a number of pleiotropic effects that reduce the risk of carbohydrate metabolism disorder progression and the development of CVD. In PCOS, ovarian dysfunction contributes to a cascade of metabolic and vascular changes even in the absence of T2DM. Therefore, the indications for metformin in patients with PCOS may extend beyond the glycemic control.

This article is a summary of the expert council on the issues of managing adult patients with PCOS, taking into account current knowledge of reproductive, metabolic, and cardiovascular risks. It also contains the key data on the use of metformin in women with PCOS in various clinical situations and the legal aspects of metformin use in modern clinical practice.

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The authors declare that there are no conflicts of interest present.