Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in women
of childbearing age. Due to hyperandrogenism and chronic anovulation affected women
may suffer from hirsutism, androgenetic alopecia, acne, menstrual disturbance and
sub-/infertility. Furthermore underlying insulin resistance promotes hyperandrogenemia,
overweight and risk for diabetes. Therefore, routine evaluation of glycemic status
is recommended. Treatment strategies are based on therapeutic lifestyle changes and
focus on patient-important complaints. First line pharmacologic treatment for infertility
in women with PCOS is letrozole. Clomiphene and metformin can be used alternatively
with lower success rates. Women seeking medical advice for hyperandrogenism can be
offered oral contraceptive pills with the lowest effective estrogen dose without any
preference of a certain gestagen. Risk for deep vein thrombosis should be taken into
account when choosing estrogen dose and type of gestagen. Antiandrogen substances
such as spironolactone should only be prescribed in combination with safe contraception
due to their risk of fetal undervirilisation. Additionally, substance specific risks
should be considered. Baseline treatment of overweight or metabolic issues includes
behaviour modification, weight reduction and physical activity. Additional benefit
can be reached by combination of lifestyle changes with metformin. Studies indicate
a positive effect of inositol and antidiabetic substances like liraglutide and empagliflozin
but should be regarded as experimental therapies.
Das polyzystische Ovarsyndrom (PCOS) umfasst ein weites Symptomspektrum – von Hirsutismus,
Alopezie, Akne, Adipositas, Sub-/Infertilität und Insulinresistenz bis zum Diabetes
mellitus mit wesentlich eingeschränkter Lebensqualität der Patientinnen [1]. Dieser Beitrag bietet eine kurze Übersicht zum Management des PCOS mit den Neuerungen
zu Diagnostik und Therapie der aktuellen Leitlinie des International PCOS Network
[2].
Schlüsselwörter
polyzystisches Ovarsyndrom - Anovulation - Hyperandrogenismus - Hirsutismus - Insulinresistenz
Key words
polycystic ovary syndrome - anovulation - hyperandrogenism - hirsutism - insulin resistance
