Volume 03 Issue 02-2023
83
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
02
P
AGES
:
83-87
SJIF
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FACTOR
(2021:
5.
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893
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OCLC
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1121105677
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ABSTRACT
The author of this article presents a modern understanding of the problem of polycystic ovary syndrome (PCOS). PCOS
is a multifactorial, genetically determined pathological condition, in the pathogenesis of which an important role
belongs to disorders of gonadotropic regulation, hyperandrogenism, insulin resistance, adipose tissue dysfunction
and other factors. Obviously, PCOS is a socially significant gynecological pathology of early reproductive age, which
requires optimization of the diagnosis and management of such patients from adolescence.
Research Article
POLYCYSTIC OVARY SYNDROME: A MODERN VIEW ON THE PROBLEM
Submission Date:
February 18, 2023,
Accepted Date:
February 23, 2023,
Published Date:
February 28, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue02-16
Jamolbek A. Djuraev
Tashkent Medical Academy, Uzbekistan
Abdurasul J. Botirov
Tashkent Medical Academy, Uzbekistan
Azizkhon Z. Shaumarov
Tashkent Medical Academy, Uzbekistan
Sabina Sodikova
Kimyo International University In Tashkent, Uzbekistan
Sabrina Kuddusova
Kimyo International University In Tashkent, Uzbekistan
Dilafruz Turabaeva
Kimyo International University In Tashkent, Uzbekistan
Mukhammadalieva Nurjakhon
Kimyo International University In Tashkent, Uzbekistan
Ambarjon Nurmetova
Kimyo International University In Tashkent, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 02-2023
84
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
02
P
AGES
:
83-87
SJIF
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MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
In adolescents, PCOS is diagnosed in the presence of clinical hyperandrogenism and an irregular menstrual cycle, while
ultrasound criteria are not always reliable. For an individual approach and choice of treatment tactics, it is extremely
important to verify the diagnosis of PCOS in a timely manner, determine the clinical phenotype and take into account
the reproductive plans of the patient.
KEYWORDS
Hyperandrogenism, anovulation, infertility.
INTRODUCTION
According to the European Society of Human
Reproduction and Embryology, American Society for
Reproductive Medicine (ESHRE/ASRM), PCOS is one of
the most common forms of endocrinopathy, occurring
in 5
–
10% of women of reproductive age. In the
reproductive period with PCOS, there is an increased
risk of anovulation and infertility. Thus, according to
the data, the frequency of PCOS in the reproductive
period is 11%, in cases of endocrine infertility it reaches
70% [1, 2]. Of particular difficulty are the issues of early
diagnosis and management of such patients in
adolescence.
According to the Russian Society of Obstetricians-
Gynecologists and Endocrinologists, the prevalence of
this syndrome in the general population of the female
population of reproductive age ranges from 8 to 21%
[3]. The purpose of this work is to study the analysis of
the main diagnostic criteria for PCOS, as well as
modern possibilities of therapy.
MATERIALS AND METHODS
The analysis of modern scientific publications devoted
to the problem of PCOS was carried out. The search
was carried out in domestic and foreign databases -
PubMed, Medline, with an emphasis on the
recommendations of international evidence-based
guidelines for the assessment and treatment of the
authors'
own
observations.
Main
part.
Etiopathogenesis. PCOS is a polyetiological endocrine
disease caused by both hereditary factors (genetic and
epigenetic) and environmental factors [4,5]. The
pathophysiological basis of PCOS is ovarian
hyperandrogenism, which occurs as a result of
impaired neuroendocrine regulation of pubertal
reactivation of the hypothalamic-pituitary-gonadal
axis. The risk of developing this pathology increases by
30
–
50% in patients with a family history of PCOS [6].
In recent studies, it has been established that
hyperinsulinemia can be the pathogenetic basis for
increased endogenous production of androgens. At
the same time, two mechanisms have been described
that explain the relationship between high insulin
concentration and hyperandrogenemia [7,8]. First,
insulin is able to directly stimulate the expression of
the ovarian enzymes P450c17 and P450scc, thereby
increasing androgen production. Hyperinsulinemia
directly increases the frequency and amount of
gonadotropin-releasing hormone release. The LH / FSH
ratio increases, and as a result, the follicles do not
mature, persist for a long time at the primary and
Volume 03 Issue 02-2023
85
International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
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SJIF
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(2021:
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5.
893
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(2023:
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Publisher:
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Servi
secondary stages, which leads to the formation of
cystic atresia in the ovaries - small follicular cysts,
ranging in size from 2 to 6 mm. [9].
The second mechanism is indirect, when GI in the liver
reduces the production of proteins that bind two types
of insulin-like growth factors (IGF-1). As a result, the
level of free androgens in the blood increases: the
levels of IGF-1 and free biologically active testosterone
increase, which leads to disruption of menstrual
function and folliculogenesis in the ovaries [10,11]. In
addition to the mainstream theories, a number of
studies suggest an association of low vitamin D levels
with the development of PCOS. Vitamins of group B (B2
and B3) have a hormone-like effect and perform a
number of biological functions through endocrine and
intracrine mechanisms [12].
Diagnostic criteria Diagnosis of PCOS is based on the
assessment of complaints, medical history, menstrual,
ovulatory function, the results of clinical and
laboratory manifestations of hyperandrogenism, as
well as an assessment of ovarian function using
ultrasound of the pelvic organs. The classic diagnostic
criteria for PCOS, formulated in 1990 by a group of
experts from the NIH (National Institutes of Health),
USA, were recognized as clinical hyperandrogenism
and/or hyperandrogenemia and chronic anovulation.
According
to
the
recommendations
of
the
International evidence-based guideline for the
assessment and management of polycystic ovary
syndrome, approved in 2018, experts supported the
Rotterdam diagnostic criteria for PCOS in adult women
after excluding comorbidities. [13].
Features of the diagnosis of PCOS in adolescence It is
well known that physiological changes in puberty can
be characterized by transient hyperandrogenism and
insulin resistance. So, during the formation of the
reproductive system, there are significant changes in
the quantity, daily rhythm, and the ratio of a number of
hormones. In some young women, the anovulatory
menstrual cycle may persist up to 5-6 years after
menarche. So, according to M. Hickey et al. (2011),
anovulatory cycles in the first year after menarche
were 85%, in the third year - 59%, after 6 years - 25% of
girls [14]. Thus, the difficulty of diagnosing PCOS at a
young age lies in the need to differentiate physiological
(transient) changes in hormonal secretion in puberty
with the onset of PCOS. In 2017, international
consensus proposed criteria for the diagnosis of PCOS
in adolescence. Mandatory criteria are: irregular
menstrual cycle or oligomenorrhea; confirmed
hyperandrogenism: progressive hirsutism, increased
levels of total and free testosterone. According to
Hickey M et al. (2011), anovulatory cycles in the first
year after menarche were 85%, in the third year - 59%,
after 6 years - 25% of girls. [15].
CONCLUSION
According to sources, the patterns of inheritance of
this disease have not been fully studied, however,
taking
into
account
clinical
and
laboratory
heterogeneity, this syndrome probably has a polygenic
or multifactorial type of inheritance. Further study of
the problems in PCOS will make it possible to learn
about the etiopathogenesis, risk factors, improve the
diagnostics necessary for early detection and timely
treatment of both ovarian dysfunction and
reproductive dysfunction, as well as manifestations of
hyperandrogenism, associated metabolic disorders
and psychological disorders.
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Volume 03 Issue 02-2023
86
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
02
P
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:
83-87
SJIF
I
MPACT
FACTOR
(2021:
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OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
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Volume 03 Issue 02-2023
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International Journal of Medical Sciences And Clinical Research
(ISSN
–
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VOLUME
03
ISSUE
02
P
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:
83-87
SJIF
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MPACT
FACTOR
(2021:
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(2022:
5.
893
)
(2023:
6.
184
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OCLC
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Publisher:
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