Мультидисциплинарный взгляд на синдром поликистоза яичников: синергия подходов

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.

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