A multidisciplinary approach to polycystic ovary syndrome: synergy of methods

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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