Endocrine Abstracts

JOINT2628

The question was the title of a paper published in 2012*, a debate between pro: John C. Marshall and con: Andrea Dunaif reflecting the division in this important topic (not only in therapy). The polycystic ovary syndrome has a wrong and misleading name. It is the most common female endocrine disorder lasting throughout life, a combination of hyperandrogenism and ovarian dysfunction, with detectable insulin resistance in most cases (if we disregard the anovulation – polycystic ovary phenotype of the Rotterdam criteria). Further arbitrary phenotypes were formed with different therapy advice despite the symptoms change from time to time but the patient remains the same. The lack of a comprehensive view and the fragmented treatment options fail to achieve overall improvement of the patients. However, if we join the AES concept (a syndrome combining hyperandrogenism with ovarian dysfunction), this increases the homogeneity of the patients giving more chance to find a common treatment. The authors have been using metformin since the discovery of insulin resistance in PCOS, thus replacing the controversial combined contraceptive pill that reduces hyperandrogenism but maintains anovulation, the other fundamental problem in the syndrome. The metformin monotherapy era was followed by the combination of metformin + life-style changes, and most recently, vitamin D3 was added to the uniform treatment. All these metformin-based therapy variants have improved almost all symptoms including infertility. The metformin + life-style changes was better than metformin monotherapy but the recent addition of vitamin D doesn’t seem more advantageous (detailed results will be presented during the congress). The authors’ answer is yes: all women with PCOS should be treated for insulin resistance, and probably the ‘male equivalents’, too. *J.C. Marshall and Andrea Dunaif: Fertility and Sterility Vol. 97, No.1, January 2012.