Recent updates in the management of PCOS

M3 India Newsdesk Aug 03, 2018

The prevalence rate of PCOS in India is estimated to be 18%. While earlier, treating PCOS was mostly about managing symptoms, today, there is more evidence-based research that is helping doctors think of different treatment options. This article focuses on the recent advancements in the management of PCOS.

Here are a few studies that show great promise for new advancements in PCOS management.

AZD4901- A new approach for treating central neuroendocrine pathophysiology of PCOS

AZD4901 may be effective in reducing the LH pulse frequency thereby, reducing the circulating luteinizing hormone and testosterone.

A recent study showed that the most useful aspect of AZD4901 is that it selectively reduces the LH pulse frequency without shutting down the entire reproductive axis which would result in a pseudo-menopausal state. PCOS is characterised by luteinizing hormone hypersecretion and hyperandrogenism.

The study demonstrated that AZD4901, a specific neurokinin-3 [NK3] receptor antagonist was effective in treating this central neuroendocrine pathophysiology of PCOS. The luteinizing hormone hypersecretion and hyperandrogenism in PCOS is due to an increase in luteinizing hormone (LH) pulse frequency.

Though this study seemed promising, it was only a 28-day double-blind, double-dummy, placebo-controlled, phase 2 trial which included 67 patients. There is a need for a longer trial involving more patients to assess the clinical outcome of AZD4901.

Article: Neurokinin B Receptor Antagonism in Women With Polycystic Ovary Syndrome: A Randomized, Placebo-Controlled Trial. George JT, Kakkar R, Marshall J, Scott ML, Finkelman RD, Ho TW, Veldhuis J, Skorupskaite K, Anderson RA, McIntosh S, Webber L. J Clin Endocrinol Metab. 2016

Mineral supplementation effective in the management of PCOS

Mineral supplement containing magnesium, zinc, calcium and vitamin D had a positive impact in PCOS patients by reducing the testosterone levels, inflammation and oxidative stress.

The study was a randomised, double-blind placebo-controlled trial in 60 women who had PCOS, for 12 weeks and it demonstrated a positive impact of magnesium, zinc, calcium, and vitamin D supplementation in PCOS patients. Doctors have called for further research to understand the effect of supplementation on the gene expression of inflammation and oxidative stress.

Article: Magnesium-Zinc-Calcium-Vitamin D Co-supplementation Improves Hormonal Profiles, Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial. Maktabi M, Jamilian M, Asemi Z. Biol Trace Elem Res. 2018

Anti-Müllerian hormone levels rise in pregnant women with PCOS

Increased prenatal exposure to AMH levels followed by GnRH receptor signaling can cause neuroendocrine dysfunction of PCOS.

The cohort study performed found that AMH levels were significantly elevated in pregnant women with PCOS than in normal healthy pregnant women.

These results were replicated in another trial conducted in pregnant mice when they were treated with AMH, following which the progeny were tested for neuroendocrine phenotype postnatally. Masculization of the exposed fetus was noted followed by a PCOS-like condition and neuroendocrine phenotype in adulthood.

This study found that the affected females had hyperactivated gonadotropin-releasing hormone (GnRH) neurons and GnRH antagonist treatment restored their neuroendocrine phenotype to a normal state in the adult female offspring. GnRH antagonist treatment restored neuroendocrine phenotype to normal in the adult offspring. These findings could pave the way for a new potential strategy to treat PCOS during adulthood.

Article: Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood. Tata B, Mimouni N, Barbotin A, et al. Nature Medicine. 2018

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