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Published in: Archives of Gynecology and Obstetrics 3/2012

01-03-2012 | General Gynecology

Diagnosis and therapy of polycystic ovarian syndrome: results of a survey among German gynecologists with a review on literature

Published in: Archives of Gynecology and Obstetrics | Issue 3/2012

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Abstract

Objective

Polycystic ovarian syndrome is one of the most frequent endocrine dysfunctions in women in their fertile age. To date, a clear definition of the disease remains controversial among experts, partly because study results concerning diagnostics and therapy are incoherent. In this survey, we intend to give an insight into the diagnostics and treatment regimes of PCOS in Germany and subsequently compare these results to the current recommendations found in international literature.

Design

In 2005, 7,000 outpatient gynecologists received a questionnaire with questions on PCOS definition, diagnostics and treatment.

Results

The survey shows that it remains difficult for gynecologists to restrict themselves to the few definition criteria defined in the 2003 Rotterdam PCOS Consensus Workshop. Nevertheless, therapy and diagnosis of PCOS show a uniform treatment pattern. The current recommendations found in international literature have been widely implemented into clinical practice. Modern therapeutic approaches such as the use of metformin are increasingly acknowledged.

Conclusion

Further studies dealing with the diagnosis and therapy of PCOS will be necessary in order to establish guidelines, especially when looking at patients without a desire for reproduction.
Appendix
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Literature
2.
go back to reference Hart R, Hickey M, Franks S (2004) Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 18:671–683PubMedCrossRef Hart R, Hickey M, Franks S (2004) Definitions, prevalence and symptoms of polycystic ovaries and polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 18:671–683PubMedCrossRef
3.
go back to reference Matalliotakis I, Kourtis A, Koukoura O, Panidis D (2006) Polycystic ovary syndrome: etiology and pathogenesis. Arch Gynecol Obstet 274:187–197PubMedCrossRef Matalliotakis I, Kourtis A, Koukoura O, Panidis D (2006) Polycystic ovary syndrome: etiology and pathogenesis. Arch Gynecol Obstet 274:187–197PubMedCrossRef
4.
go back to reference ESHRE Rotterdam/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19:41–47CrossRef ESHRE Rotterdam/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19:41–47CrossRef
5.
go back to reference Laven JSEM, Imani B, Eijkemans MJC, Fauser BCJM (2002) New approach to polycystic ovary syndrome and other forms of anovulatory infertility. Obstet Gynecol Surv 57:755–767PubMedCrossRef Laven JSEM, Imani B, Eijkemans MJC, Fauser BCJM (2002) New approach to polycystic ovary syndrome and other forms of anovulatory infertility. Obstet Gynecol Surv 57:755–767PubMedCrossRef
6.
go back to reference Fraser IS, Kovacs G (2004) Current recommendations for the diagnostic evaluation and follow-up of patients presenting with symptomatic polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 18:813–823PubMed Fraser IS, Kovacs G (2004) Current recommendations for the diagnostic evaluation and follow-up of patients presenting with symptomatic polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 18:813–823PubMed
7.
go back to reference Lakhani K, Seifalian AM, Atiomo WU, Hardiman P (2002) Polycystic ovaries. Br J Radiol 75:9–16PubMed Lakhani K, Seifalian AM, Atiomo WU, Hardiman P (2002) Polycystic ovaries. Br J Radiol 75:9–16PubMed
8.
go back to reference Taylor AE, McCourt B, Martin KA et al (1997) Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab 82:2248–2256PubMedCrossRef Taylor AE, McCourt B, Martin KA et al (1997) Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab 82:2248–2256PubMedCrossRef
9.
go back to reference Pasquali R, Antenucci D, Casimirri F et al (1989) Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss. J Clin Endocrinol Metab 68:173–179PubMedCrossRef Pasquali R, Antenucci D, Casimirri F et al (1989) Clinical and hormonal characteristics of obese amenorrheic hyperandrogenic women before and after weight loss. J Clin Endocrinol Metab 68:173–179PubMedCrossRef
10.
go back to reference Kiddy DS, Hamilton-Fairley D, Bush A et al (1992) Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 36:105–111CrossRef Kiddy DS, Hamilton-Fairley D, Bush A et al (1992) Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 36:105–111CrossRef
11.
go back to reference Kirchengast S, Huber J (2001) Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome. Hum Reprod 16:1255–1260PubMedCrossRef Kirchengast S, Huber J (2001) Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome. Hum Reprod 16:1255–1260PubMedCrossRef
12.
go back to reference Stein IF, Leventhal ML (1935) Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 29:181–191 Stein IF, Leventhal ML (1935) Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 29:181–191
13.
go back to reference Silfen ME, Denburg MR, Manibo AM et al (2003) Early endocrine, metabolic, and sonographic characteristics of polycystic ovary syndrome (PCOS): comparison between nonobese and obese adolescents. J Clin Endocrinol Metab 88:4682–4688PubMedCrossRef Silfen ME, Denburg MR, Manibo AM et al (2003) Early endocrine, metabolic, and sonographic characteristics of polycystic ovary syndrome (PCOS): comparison between nonobese and obese adolescents. J Clin Endocrinol Metab 88:4682–4688PubMedCrossRef
14.
go back to reference Moran L, Norman RJ (2004) Understanding and managing disturbances in insulin metabolism and body weight in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 18:719–736PubMedCrossRef Moran L, Norman RJ (2004) Understanding and managing disturbances in insulin metabolism and body weight in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 18:719–736PubMedCrossRef
15.
go back to reference Talbott E, Guzick D, Clerici A et al (1995) Coronary heart disease risk factors in women with polycystic ovary syndrome. Arterioscler Thromb Vasc Biol 15:821–826PubMedCrossRef Talbott E, Guzick D, Clerici A et al (1995) Coronary heart disease risk factors in women with polycystic ovary syndrome. Arterioscler Thromb Vasc Biol 15:821–826PubMedCrossRef
16.
go back to reference Legro RS, Kunselman AR, Dodson WC, Dunaif A (1999) Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 84:165–169PubMedCrossRef Legro RS, Kunselman AR, Dodson WC, Dunaif A (1999) Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 84:165–169PubMedCrossRef
17.
go back to reference Vrbikova J, Bendlova B, Hill M, Vankova M, Vondra K, Starka L (2002) Insulin sensitivity and beta-cell function in women with polycystic ovary syndrome. Diabetes Care 25:1217–1222PubMedCrossRef Vrbikova J, Bendlova B, Hill M, Vankova M, Vondra K, Starka L (2002) Insulin sensitivity and beta-cell function in women with polycystic ovary syndrome. Diabetes Care 25:1217–1222PubMedCrossRef
18.
19.
go back to reference Elsenbruch S, Hahn S, Kowalsky D et al (2003) Quality of life, psychosocial well-being, and sexual satisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab 88:5801–5807PubMedCrossRef Elsenbruch S, Hahn S, Kowalsky D et al (2003) Quality of life, psychosocial well-being, and sexual satisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab 88:5801–5807PubMedCrossRef
20.
go back to reference Cattrall FR, Healy DL (2004) Long-term metabolic, cardiovascular and neoplastic risks with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 18:803–812PubMedCrossRef Cattrall FR, Healy DL (2004) Long-term metabolic, cardiovascular and neoplastic risks with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 18:803–812PubMedCrossRef
21.
22.
go back to reference Archer JS, Chang RJ (2004) Hirsutism and acne in polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 18:737–754PubMedCrossRef Archer JS, Chang RJ (2004) Hirsutism and acne in polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 18:737–754PubMedCrossRef
23.
go back to reference Schüring AN, Kiesel L (2005) Hormonelle Therapie des polyzystischen Ovarsyndroms (PLOS). Gynäkologe 38:333–341CrossRef Schüring AN, Kiesel L (2005) Hormonelle Therapie des polyzystischen Ovarsyndroms (PLOS). Gynäkologe 38:333–341CrossRef
24.
go back to reference Graf M (2006) CME Praktische Fortbildung—Gynäkologie, Geburtsmedizin und Gynäkologische Endokrinologie, akademos Wissenschaftsverlag, Hamburg, Germany 3 Graf M (2006) CME Praktische Fortbildung—Gynäkologie, Geburtsmedizin und Gynäkologische Endokrinologie, akademos Wissenschaftsverlag, Hamburg, Germany 3
25.
go back to reference Dahlgren E, Landin K, Krotkiewski M, Holm G, Janson PO (1998) Effects of two antiandrogen treatments on hirsutism and insulin sensitivity in women with polycystic ovary syndrome. Hum Reprod 13:2706–2711PubMed Dahlgren E, Landin K, Krotkiewski M, Holm G, Janson PO (1998) Effects of two antiandrogen treatments on hirsutism and insulin sensitivity in women with polycystic ovary syndrome. Hum Reprod 13:2706–2711PubMed
26.
27.
go back to reference Palombo-Kinne E, Schellschmidt I, Schumacher U, Graser T (2009) Efficacy of a combined oral contraceptive containing 0.030 mg ethinylestradiol/2 mg dienogest for the treatment of papulopustular acne in comparison with placebo and 0.035 mg ethinylestradiol/2 mg cyproterone acetate. Contraception 79:282–289PubMedCrossRef Palombo-Kinne E, Schellschmidt I, Schumacher U, Graser T (2009) Efficacy of a combined oral contraceptive containing 0.030 mg ethinylestradiol/2 mg dienogest for the treatment of papulopustular acne in comparison with placebo and 0.035 mg ethinylestradiol/2 mg cyproterone acetate. Contraception 79:282–289PubMedCrossRef
28.
go back to reference Saleh AM, Khalil HS (2004) Review of nonsurgical and surgical treatment and the role of insulin-sensitizing agents in the management of infertile women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 83:614–621PubMed Saleh AM, Khalil HS (2004) Review of nonsurgical and surgical treatment and the role of insulin-sensitizing agents in the management of infertile women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 83:614–621PubMed
29.
go back to reference Homburg R (2004) Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynecol 18(5):773–788CrossRef Homburg R (2004) Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynecol 18(5):773–788CrossRef
30.
go back to reference Al-Azemi M, Omu FE, Omu AE (2004) The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome. Arch Gynecol Obstet 270:205–210PubMedCrossRef Al-Azemi M, Omu FE, Omu AE (2004) The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome. Arch Gynecol Obstet 270:205–210PubMedCrossRef
31.
go back to reference Clark AM, Ledger W, Galletly C et al (1995) Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod 10:2705–2712PubMed Clark AM, Ledger W, Galletly C et al (1995) Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod 10:2705–2712PubMed
32.
go back to reference Crosignani PG, Colombo M, Vegetti W, Somigliana E, Gessati A, Ragni G (2003) Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum Reprod 18:1928–1932PubMedCrossRef Crosignani PG, Colombo M, Vegetti W, Somigliana E, Gessati A, Ragni G (2003) Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum Reprod 18:1928–1932PubMedCrossRef
33.
go back to reference Homburg R (2004) Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 18:773–788PubMedCrossRef Homburg R (2004) Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 18:773–788PubMedCrossRef
34.
go back to reference Muth S, Norman J, Sattar N, Fleming R (2004) Women with polycystic ovary syndrome (PCOS) often undergo protracted treatment with metformin and are disinclined to stop: indications for a change in licensing arrangements? Hum Reprod 19:2718–2720PubMedCrossRef Muth S, Norman J, Sattar N, Fleming R (2004) Women with polycystic ovary syndrome (PCOS) often undergo protracted treatment with metformin and are disinclined to stop: indications for a change in licensing arrangements? Hum Reprod 19:2718–2720PubMedCrossRef
35.
go back to reference Kelly CJ, Gordon D (2002) The effect of metformin on hirsutism in polycystic ovary syndrome. Eur J Endocrinol 147:217–221PubMedCrossRef Kelly CJ, Gordon D (2002) The effect of metformin on hirsutism in polycystic ovary syndrome. Eur J Endocrinol 147:217–221PubMedCrossRef
36.
go back to reference Hahn S, Quadbeck B, Elsenbruch S et al (2004) Metformin, an efficacious drug in the treatment of polycystic ovary syndrome. Dtsch Med Wochenschr 129:1059–1064PubMedCrossRef Hahn S, Quadbeck B, Elsenbruch S et al (2004) Metformin, an efficacious drug in the treatment of polycystic ovary syndrome. Dtsch Med Wochenschr 129:1059–1064PubMedCrossRef
37.
go back to reference Harborne L, Fleming R, Lyall H, Sattar N, Norman J (2003) Metformin or antiandrogen in the treatment of hirsutism in polycystic ovary syndrome. J Clin Endocrinol Metab 88:4116–4123PubMedCrossRef Harborne L, Fleming R, Lyall H, Sattar N, Norman J (2003) Metformin or antiandrogen in the treatment of hirsutism in polycystic ovary syndrome. J Clin Endocrinol Metab 88:4116–4123PubMedCrossRef
38.
go back to reference Lam PM, Cheung LP, Haines C (2004) Revisit of metformin treatment in polycystic ovarian syndrome. Gynecol Endocrinol 19:33–39PubMedCrossRef Lam PM, Cheung LP, Haines C (2004) Revisit of metformin treatment in polycystic ovarian syndrome. Gynecol Endocrinol 19:33–39PubMedCrossRef
39.
go back to reference Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH (2010) Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility Cochrane Database Syst Rev (1). Report. doi:10.1002/14651858.CD003053.pub4 Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH (2010) Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility Cochrane Database Syst Rev (1). Report. doi:10.​1002/​14651858.​CD003053.​pub4
40.
go back to reference Bühling KJ, Bartley J, Lübbert H (2006) Einsatz oraler Antidiabetika in der Therapie des Kinderwunsches, des Gestationsdiabetes und zur Prävention des Typ-2- Diabetes. Geb Fra 66:1–5 Bühling KJ, Bartley J, Lübbert H (2006) Einsatz oraler Antidiabetika in der Therapie des Kinderwunsches, des Gestationsdiabetes und zur Prävention des Typ-2- Diabetes. Geb Fra 66:1–5
41.
go back to reference De Leo V, la Marca A, Ditto A, Morgante G, Cianci A (1999) Effects of metformin on gonadotropin-induced ovulation in women with polycystic ovary syndrome. Fertil Steril 72:282–285PubMedCrossRef De Leo V, la Marca A, Ditto A, Morgante G, Cianci A (1999) Effects of metformin on gonadotropin-induced ovulation in women with polycystic ovary syndrome. Fertil Steril 72:282–285PubMedCrossRef
42.
go back to reference Nestler JE, Jakubowicz DJ, Evans WS, Pasquali R (1998) Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. N Engl J Med 338:1876–1880PubMedCrossRef Nestler JE, Jakubowicz DJ, Evans WS, Pasquali R (1998) Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. N Engl J Med 338:1876–1880PubMedCrossRef
43.
go back to reference Nestler JE, Stovall D, Akhter N, Iuorno MJ, Jakubowicz DJ (2002) Strategies for the use of insulin-sensitizing drugs to treat infertility in women with polycystic ovary syndrome. Fertil Steril 77:209–215PubMedCrossRef Nestler JE, Stovall D, Akhter N, Iuorno MJ, Jakubowicz DJ (2002) Strategies for the use of insulin-sensitizing drugs to treat infertility in women with polycystic ovary syndrome. Fertil Steril 77:209–215PubMedCrossRef
44.
go back to reference Palomba S, Orio F Jr, Falbo A et al (2005) Prospective parallel randomized, double-blind, double-dummy controlled clinical trial comparing clomiphene citrate and metformin as the first-line treatment for ovulation induction in nonobese anovulatory women with polycystic ovary syndrome. J Clin Endocrinol Metab 90:4068–4074PubMedCrossRef Palomba S, Orio F Jr, Falbo A et al (2005) Prospective parallel randomized, double-blind, double-dummy controlled clinical trial comparing clomiphene citrate and metformin as the first-line treatment for ovulation induction in nonobese anovulatory women with polycystic ovary syndrome. J Clin Endocrinol Metab 90:4068–4074PubMedCrossRef
45.
go back to reference Tan SL, Farhi J, Homburg R, Jacobs HS (1996) Induction of ovulation in clomiphene-resistant polycystic ovary syndrome with pulsatile GnRH. Obstet Gynecol 88:221–226PubMedCrossRef Tan SL, Farhi J, Homburg R, Jacobs HS (1996) Induction of ovulation in clomiphene-resistant polycystic ovary syndrome with pulsatile GnRH. Obstet Gynecol 88:221–226PubMedCrossRef
46.
go back to reference Li TC, Saravelos H, Chow MS, Chisabingo R, Cooke ID (1998) Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility. Br J Obstet Gynaecol 105:338–344PubMedCrossRef Li TC, Saravelos H, Chow MS, Chisabingo R, Cooke ID (1998) Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility. Br J Obstet Gynaecol 105:338–344PubMedCrossRef
47.
go back to reference Imani B, Eijkemans MJ, te Velde ER, Habbema JD, Fauser BC (1998) Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol Metab 83:2361–2365PubMedCrossRef Imani B, Eijkemans MJ, te Velde ER, Habbema JD, Fauser BC (1998) Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol Metab 83:2361–2365PubMedCrossRef
48.
go back to reference Farquhar C, Lilford RJ, Marjoribanks J, Vandekerckhove P (2005) Laparoscopic “drilling” by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev CD001122 Farquhar C, Lilford RJ, Marjoribanks J, Vandekerckhove P (2005) Laparoscopic “drilling” by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev CD001122
49.
go back to reference Verhelst J, Gerris J, Joostens M, Van der Meer S, Van Royen E, Mahler C (1993) Clinical and endocrine effects of laser vaporization in patients with polycystic ovarian disease. Gynecol Endocrinol 7:49–55PubMedCrossRef Verhelst J, Gerris J, Joostens M, Van der Meer S, Van Royen E, Mahler C (1993) Clinical and endocrine effects of laser vaporization in patients with polycystic ovarian disease. Gynecol Endocrinol 7:49–55PubMedCrossRef
50.
go back to reference Farhi J, Soule S, Jacobs HS (1995) Effect of laparoscopic ovarian electrocautery on ovarian response and outcome of treatment with gonadotropins in clomiphene citrate-resistant patients with polycystic ovary syndrome. Fertil Steril 64:930–935PubMed Farhi J, Soule S, Jacobs HS (1995) Effect of laparoscopic ovarian electrocautery on ovarian response and outcome of treatment with gonadotropins in clomiphene citrate-resistant patients with polycystic ovary syndrome. Fertil Steril 64:930–935PubMed
Metadata
Title
Diagnosis and therapy of polycystic ovarian syndrome: results of a survey among German gynecologists with a review on literature
Publication date
01-03-2012
Published in
Archives of Gynecology and Obstetrics / Issue 3/2012
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-011-2014-7

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