Effectiveness of a differentiated approach to the treatment of patients with polycystic ovary syndrome using inositols and combined oral contraceptives in early reproductive age

Objective. To evaluate the effectiveness of treatment of girls aged 15-18 years with different phenotypes of polycystic ovary syndrome (PCOS) using combined oral contraceptives (COCs) and inositols depending on overweight and insulin resistance in girls. Materials and methods. The study included 153 patients aged 15-18years with PCOS and 32 healthy controls; girls of the study group had oligo/amenorrhea, hyperandrogenism, and polycystic ovarian morphology revealed by the ultrasound assessment. The comparative analysis of clinical and anamnestic data of patients with PCOS (n=153) and the control group (n=32) was performed at the first stage of the study. Depending on the PCOS phenotype, overweight, and insulin resistance, there were groups of hormonal and non-hormonal management; the results of the clinical examination were compared before the administration of therapy and 6 months after it. The groups were compared with each other and with the control group; the results obtained after receiving the treatment were compared with the baseline values and with the group of healthy girls. Results. Before the therapy, the patients with PCOS showed a significant increase in the level of luteinizing hormone (LH), testosterone (T), androstenedione, anti-Mullerian hormone (AMH), and free androgen index (FIA) accompanied by low levels of sex hormone-binding globulin (SHBG) (p<0.0001for all indicators) as well as significantly higher levels of 17-OHP, DHEA-S, and cortisol (p<0.005). Phenotypes B and D differed from phenotype A having higher levels of LH, T, androstenedione, and FIA (p<0.005for all indicators). After the therapy with combined oral contraceptives, patients with phenotype A showed a significant decrease in LH, T, FIA, DHEA-S, androstenedione (p<0.005for all indicators) and ovarian volume (p<0.005), but it was necessary to continue administering therapy, as the main hormonal and ultrasound characteristics were not normalized. A half of the patients with phenotypes B and D who received non-hormonal treatment with inositols showed a clinical effect after 6 months; their menstrual cycle restored and the main hormonal parameters were normalized according to the levels of LH, T, FIA, and SHBG. As the result did not demonstrate statistical signif icance and normative values, it was necessary to continue administering the non-hormonal therapy. There was no clinical effect of non-hormonal therapy in 13.6% of patients with PCOS, therefore, the therapy was changed. Conclusion. The administration of microdosed COCs with drospirenone for 6 months demonstrated its clinical effectiveness in the treatment of teenagers with classic PCOS, however, this period of administration was not sufficient for the clinical effect. It is recommended to continue the treatment of PCOS with COCs in teenagers for more than 6 months, and assess the hormonal parameters and the degree of hyperandrogenism before withdrawal of the drugs. The clinical effect was also observed in patients with non-classical PCOS after receiving non-hormonal combined therapy, namely the 5:1 ratio of myoinositol and D-chiroinositol. There was a tendency for normalization of hormonal and ultrasound parameters, which did not reach the standard values, so the therapy should be continued. However, the treatment had to be changed in 13% of the patients as they did not respond to the therapy.

polycystic ovary syndrome, overweight, insulin resistance, hyperandrogenism, hyperglycemia, myoinositol, D-chiroinositol, combined oral contraceptives