Odabir hormonske kontracepcije kod pacijentica sa sindromom policističnih jajnika

master's thesis

• Title (english): Hormonal contraceptive choice for women with polycystic ovary syndrome
• Author: Karolina Veselski
• Mentor: Dinka Pavičić-Baldani (mentor)
• Committee member: Marina Šprem Goldštajn (predsjednik povjerenstva)
• Committee member: Miro Kasum (član povjerenstva)
• Committee member: Dinka Pavičić-Baldani (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Sindrom policističnih jajnika (PCOS) je najčešći endokrinološki poremećaj žena reprodukcijske dobi. Važnost PCOS nije samo u njegovoj brojnosti, nego i u čitavom nizu značajnih i različitih kliničkih posljedica. Ovaj se sindrom povezuje s povećanim rizikom nastanka brojnih reprodukcijskih (neplodnost, hiperandrogenemija, menstruacijski poremećaji), metaboličkih (pretilost, dislipidemija, smanjena tolerancija na glukozu, dijabetes tipa 2, metabolički sindrom, nepovoljni kardiovaskularni profili), psiholoških (povećana anksioznost, depresija i smanjenje kvalitete života), te onkoloških (karcinom endometrija) bolesti i poremećaja. Iako etiologija PCOS nije u potpunosti razjašnjena, postoje snažni dokazi da složene interakcije između genetskih, okolišnih i bihevioralnih (poglavito nutritivnih) čimbenika stoje u podlozi ovog sindroma. U nedostatku jasne etiologije i patogeneze ovaj se sindrom definira temeljem Rotterdamskih kriterija koji uključuju postojanje poremećaja menstruacijskih ciklusa, kliničkih i/ili biokemijski znakova povećanog stvaranja androgena i ultrazvučnog nalaze policistične morfologije jajnika. Prisutnost dva od ova tri navedena parametra dostatna je za postavljanje dijagnoze, nakon što se isključe ostale bolesti koje oponašaju PCOS. ----- U nedostatku etiološkog uzroka liječenje je usmjereno na smanjenje simptoma i prevenciju kasnijih posljedica. U prvoj liniji liječenja dermatoloških simptoma hiperandrogenemije i poremećaja menstruacijskog ciklusa te prevencije nastanka karcinoma endometrija kod žena koje trenutačno ne planiraju trudnoću stoji oralna hormonska kontracepcija. Kod odabira hormonske kontracepcije u pacijentica s PCOS zahtijeva se individualni pristup, adekvatna obrada i procjena kardiometaboličkog rizika. Niskodozirani kontraceptivi sa neutralnim ili antiandrogenim progestinima lijek su izbora za suzbijanje znakova hiperandrogenizma i regulaciju menstruacijskog ciklusa. Iako se danas vode brojne polemike i provode razna istraživanja o dobrobitima/rizicima dugotrajnog korištenja oralne hormonske kontracepcije dokazano je da iako određeni rizici postoje, korisni i pozitivni učinci OHK ih daleko nadmašuju. Stoga ovi lijekovi ostaju zlatni standard u liječenju pacijentica s PCOS koje trenutačno ne planiraju trudnoću.

Abstract (english)

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. The importance of the PCOS is not only in its numerosity, but also in its substantial and diverse clinical consequences including reproductive (infertility, hyperandrogenism, menstrual dysfunction), metabolic (obesity, dyslipidemia, impaired glucose tolerance, type 2 diabetes, metabolic syndrome, adverse cardiovascular risk profiles), psychological features (increased anxiety, depression and reduced quality of life), and oncologic risk (endometrial cancer). Although etiology of PCOS is uncertain, there is strong evidence that complex interactions between genetic, environmental and behavioral factors contribute to causing this syndrome. ----- The Rotterdam classification is recommended for defining PCOS in the event of menstrual cycles abnormalities, clinical and/or biochemical signs of hyperandrogenism and ultrasound appearance of polycystic ovaries. The presence of two of these three criteria is sufficient once the other causes that mimic PCOS have been ruled out. In the absence of etiological cause the treatment is orientated to diminishing the symptoms and preventions of late sequel. The mainstay of the first-line therapy for all dermatologic symptoms of hyperandrogenism and menstrual cycle abnormalities are oral hormonal contraceptives.
When choosing oral contraceptives in women with PCOS, each patient requires an individual approach, adequate treatment and assessment of cardiometabolic risks. Low dose contraceptives with neutral or antiandrogenic progestagens are in the first line of therapy for combating signs of hyperandrogenism, regulation of the menstrual cycle and prevention of endometrial carcinoma. Despite numerous published studies there is still no consensus about benefit/risk of long term usage of oral hormonal contraception. It is generally agreed that although certain risks exist, positive effects of oral hormonal contraception outweigh them by far. Therefore these drugs remain the gold standard in the treatment of patients with PCOS not immediately seeking pregnancy.

• Keywords: PCOS; hormonska kontracepcija; hiperandrogenizam
• Keywords (english): PCOS; oral hormonal contraception; hyperandrogenism
• Language: croatian
• URN:NBN: urn:nbn:hr:105:945697
• 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: Open access
• Created on: 2017-06-19 07:55:46