Odabir hormonske kontracepcije ovisno o fenotipu sindroma policističnih jajnika

master's thesis

• Title (english): Hormonal contraceptive choice depending on phenotype of polycystic ovary syndrome
• Author: Eva Mikulčić
• 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: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Ovaj pregledni rad predstavlja kritički osvrt na studije koji analiziraju učinak kombinirane hormonalne kontracepcije u liječenju sindroma policističnih jajnika (PCOS). Specifični cilj rada je odrediti optimalnu terapijsku opciju za svaki pojedini fenotip PCOS. Hiperandrogenizam (HA), oligo/anovulacija i policistična morfologija jajnika (PCOM) nađena ultrazvukom ključni su parametri za postavljanje dijagnoze PCOS. Iako se inzulinska rezistencija (IR) i pretilost javljaju znatno češće u populaciji bolesnica s PCOS u odnosu na zdrave žene, ovi parametri nisu ključni za postavljanje dijagnoze. Kombinacija navedenih parametara determinira različite fenotipe PCOSa, kao i razinu metaboličkog i kardiovaskularnog rizika. Provedeno je pretraživanje dostupne literature (randomizirana klinička istraživanja te opservacijske studije) dostupne u PubMed bazi na engleskom jeziku objavljene do travnja 2018. godine. U obzir je uzeto 19 randomiziranih kliničkih pokusa i 8 opservacijskih studija koji obrađuju tematiku izbora kombinirane hormonalne kontracepcije za pojedini fenotip PCOS. Zaključuje se da svi kombinirani hormonski kontraceptivi analizirani u objavljenim radovima predstavljaju sigurnu i učinkovitu terapijsku opciju za ublažavanje simptoma u pacijentica s HA/PCOS i ta je terapija pogodna za svaki fenotip PCOS. U pacijentica s metaboličkim rizicima, koje su pretile ili imaju IR koja ne zahtijeva terapiju metforminom, kontracepcija s 17β-estradiolom te primjena vaginalnog kontracepcijskog prstena smatra se pogodnijim od oralnog kombiniranog pripravka etinil-estradiola i drospirenona ( EE/DRSP). Također, u takvih pacijentica, kombinirana hormonska kontracepcija uz mioinozitol može biti učinkovitija u kontroli metaboličkog profila. U pacijenticama s izraženim metaboličkim rizicima preferira se korištenje intrauterinog uloška s levonorgestrelom. Na budućim je istraživanjima da otkriju optimalno trajanje terapije te razjasne moguće dugoročne učinke kombinirane hormonske kontracepcije na kardiometaboličke rizike prisutne kod pacijentica s PCOS, te istraže potencijal i djelovanja novih kombiniranih hormonskih kontraceptiva.

Abstract (english)

This paper represents a critical review of the data considering the effects combined hormonal contraceptives (CHC) might have on patients with polycystic ovary syndrome (PCOS), with an aim to discover the optimal therapeutic option for each of the PCOS phenotypes. Hyperandrogenism (HA), oligo/anovulation and polycystic ovarian morphology (PCOM) on ultrasound exam are the main diagnostic criteria for establishing PCOS diagnosis. Although insulin resistance (IR) and obesity are more fequently observed in patients with PCOS they are not necessary for the diagnosis. The combination of mentioned parametars defines various phenotypes of PCOS, as well as the corresponding metabolic and cardiovascular risk. A literature search has been conducted, examining any randomised clinical trial (RCT) or observational study in the PubMed database pertaining to the subject in question, that was published until April 2018, in English.19 RCTs and 8 observational studies on the subject have been analysed. Conclusions of this paper are that CHC represent a safe and effective therapeutic option for PCOS patients of any phenotype and are known to alleviate symptoms in PCOS patients with HA/PCOS. For overweight patients, patients with a mild IR that does not require metformin treatment, and those with other metablic risks, contraception with 17β estradiol or vaginal contraceptive ring seems to be preferred to oral EE/DRSP combination. The combination of myo-inositol and CHC in these patients may control metabolic profiles more effectively. For PCOS patients with pronounced metabolic risks IUS with levonorgestrel could represent the safest option. Further, more detailed trials on the effects of CHC on PCOS patients will provide a valuable improvment in our understanding of the topic, suggest optimal duration, as well as long-term effects of the treatment, especially on metabolism, with a focus on new CHCs.

• Keywords: hirzutizam; hormonska kontracepcija; PCOS; jajnik
• Keywords (english): Hirsutism; hormonal contraception; polycystic ovary syndrome; ovary
• Language: croatian
• URN:NBN: urn:nbn:hr:105:437307
• 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: 2019-01-04 09:48:07