RAMB Novembro/Dezembro 2015

oares

. JM

486

ssoc

ras

2015; 61(6):485-487

sarily have clinical or laboratory hyperandrogenism as-

sociated with chronic anovulation and/or polycystic

ovaries images.

Carbohydrate or lipid metabolism dis-

orders are not part of the diagnosis, but are important

factors for prognosis, mainly due to cardiovascular risk.

In general, the therapy employed does not address

the cause, but ameliorates the effects or complications

associated with the disease: a) menstrual dysfunction; b)

hyperandrogenism; c) infertility; d) metabolic changes; e)

prevention of cardiovascular diseases and cancer.

The main pillar of therapy is to change lifestyle hab-

its, increasing physical activity (3 to 5x per week), reduc-

ing daily stress, proper nutritional diet and psychologi-

cal support.

10,17

If there is no adherence to treatment or

if the response is inadequate, drug therapy is recommend-

ed. Exceptionally, laparoscopic ovarian drilling is an al-

ternative used in extreme cases, in which there was no

successful medical treatment.

In overweight and obese women, the main strategy

is weight loss. With reduction greater than 5%, there may

be clinical improvement with recovery of menstrual pat-

tern and ovulation. Curi et al.

showed that physical ac-

tivity 40 minutes a day, three times a week, associated

with appropriate nutritional diet has an effect similar to

metformin. In addition, changes in life habits provide an-

other beneficial effect: reduction of the abdominal cir-

cumference (related to the visceral fat and cardiovascu-

lar risk).

Regarding menstrual patterns and hirsutism, com-

bined oral hormonal contraceptives are very effective be-

cause they reduce the circulating levels of androgens, reg-

ulate the cycles, and protect the endometrium.

However,

this treatment does not improve insulin resistance, and

may eventually even worsen it depending on the type of

progestogen used.

In more severe cases of hirsutism, anti-androgenic

agents, such as cyproterone acetate, spironolactone, fin-

asteride and flutamide, may be added. The latter drug

should be used with caution due to deleterious effects to

the liver.

Usually, creams with these active ingredients

and other cosmetic procedures can be adjuvants for fast-

er skin improvement.

For carbohydrate metabolism, the primary product

remains metformin,

but the development of biological

drugs which help weight loss, such as liraglutide, may be

promising.

Although stimulation of ovulation is effective with

the use of clomiphene, pregnancy rates are not high, re-

quiring more complex techniques of assisted reproduc-

tion. Perhaps the genetic and morphological changes of

the endometrium are crucial in the fertility of women

with PCOS.

More than a reproductive disorder, PCOS should be

viewed as a complex metabolic disease that requires glob-

al therapeutic approach, since it is a risk factor for dis-

eases such as diabetes and endometrial cancer and pos-

sibly cardiovascular disease.

Treatment should be individualized according to clin-

ical presentation, whether the patient wants to become

pregnant, and the risk of developing long-term compli-

cations.

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