Ciljevi liječenja žena sa sindromom policističnih jajnika

master's thesis

• Title (english): Treatment goals in women with polycystic ovary syndrome
• Author: Lucija Milišić
• Mentor: Ivana Pavlić-Renar (mentor)
• Committee member: Darko Kaštelan (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Ivana Pavlić-Renar (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2015-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Sindrom policističnih jajnika (PCOS) najčešći je endokrinološki poremećaj kod žena reproduktivne dobi. Karakteriziran je menstrualnim poremećajima, hiperandrogenizmom i policističnim jajnicima te ima mnogo potencijalnih metaboličkih i kardiovaskularnih rizika. Pristup liječenju treba biti individualan i mora obuhvatiti sve simptome. Prije početka bilo kojeg oblika farmakološkog liječenja ili kirurške terapije, promjene u načinu života moraju biti prva preporuka jer mogu poboljšati endokrini profil i normalizirati menstruacijski ciklus i ovulacije. Prva linija liječenja za izazivanje ovulacije je klomifen citrat. On se može kombinirati s metforminom u bolesnika s inzulinskom rezistencijom. Gonadotropini su izbor liječenja kod bolesnika koji su rezistentni na klomifen te se mogu primijeniti u obliku low-dose step-up i low-dose step-down protokola. Ultrazvučno praćenje odgovora jajnika je potrebno za vrijeme stimulacije s gonadotropinima kako bi se izbjegle neželjene komplikacije poput sindroma hiperstimulacije jajnika i višestruke trudnoće. Postoje i druge alternativne mogućnosti ako klomifen ne izaziva ovulaciju i trudnoću: inhibitori aromataze, laparoskopska elektrokoagulacija jajnika i IVF. Oralne kontracepcijske pilule su mogućnost liječenja hirzutizma, a ako one ne postignu željene rezultate, mogu se dodati antiandrogeni kao što je spironolakton. Menstrualni poremećaji mogu se liječiti kombiniranom hormonskom kontracepcijom, progestinima ili GnRH agonistima.

Abstract (english)

Polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder in women of reproductive age. It is characterized by menstrual disorder, hypandrogenism and polycystic ovaries and has many potential metabolic and cardiovascular risks. Treatment should be individualized and must include all symptoms. Before starting any form of medication or surgical therapy, change in lifestyle must be the first recommendation as it could improve the endocrine profile and normalize menstrual cycle and ovulation. The first line treatment for the induction of ovulation is clomiphene citrate. It can be combined with metformin in patients with insulin resistance. Gonadotropins are the treatment of choice in patients who are resistant to clomiphene citrate and may be applied as a low-dose step-up and a low-dose step-down protocol. Ultrasound monitoring of ovarian response is required during stimulation with gonadotropins in order to avoid unwanted complications such as ovarian hyperstimulation syndrome and multiple pregnancy. There are also other alternative possibilities if clomiphene fails to induce ovulation and pregnancy: aromatase inhibitors, laparoscopic ovarian drilling and IVF. Oral contraceptive pills are treatment option for management of hirsutism and if they do not produce results, antiandrogens, such as spironolactone, can be added. Menstrual related disorders are treated by combined hormonal contraceptives, progestins or GnRH agonists.

• Keywords: sindrom policističnih jajnika; liječenje; klomifen citrat; oralna kontracepcija
• Keywords (english): polycystic ovary syndrome; treatment; clomiphene citrate; oral contraceptive pills
• Language: croatian
• URN:NBN: urn:nbn:hr:105:024976
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Access restricted to students and staff of home institution
• Created on: 2016-12-01 10:41:22