Subject(s)
Anti-Mullerian Hormone/blood , Diabetes Mellitus, Type 1/physiopathology , Down-Regulation , Ovarian Reserve , Adult , Biomarkers/blood , Cohort Studies , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/drug therapy , Female , Glycated Hemoglobin/analysis , Humans , Hyperglycemia/prevention & control , Hypoglycemia/prevention & control , Hypoglycemic Agents/adverse effects , Hypoglycemic Agents/therapeutic use , Insulin/adverse effects , Insulin/therapeutic use , Longitudinal Studies , Ovarian Reserve/drug effectsABSTRACT
Polycystic ovary syndrome is a multi-system endocrinopathy with long-term metabolic and cardiovascular health consequences. Patients typically present due to symptoms of irregular menstruation, hair growth, or infertility; however, recent management options are aimed at further treating underlying glucose-insulin abnormalities as well as androgen excess for proactive control of symptoms. By a 2003 international consensus conference, diagnosis is made by two out of three criteria: chronic oligoovulation or anovulation after excluding secondary causes, clinical or biochemical evidence of hyperandrogenism (but not necessarily hirsutism due to inter-patient variability in hair follicle sensitivity), and radiological evidence of polycystic ovaries. Traditional medical treatment options include oral contraceptive pills, cyclic progestins, ovulation induction, and anti-androgenic medications (aldosterone antagonist, 5alpha-reductase antagonist, and follicle ornithine decarboxylase inhibitor). Recent pharmacotherapies include insulin-sensitizing medications metformin and two thiazolidinediones (rosiglitazone/Avandia and pioglitazone/Actos), a CYP19 aromatase inhibitor (letrozole/Femara), and statins to potentially lower testosterone levels.