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PCOS and Insulin Resistance (IR): From Lifestyle to Insulin Sensitizers

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Frontiers in Gynecological Endocrinology

Part of the book series: ISGE Series ((ISGE))

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Abstract

PCOS patients are typically characterized by chronic anovulation, hyperandrogenism, polycystic ovaries and these aspects are frequent in a high percentage of women during the repruductive life. PCOS frequently show overweight and/or obesity and are characterized by a higher production of androgens and reduced sensitivity to insulin. In fact it is of great importance to note that up to 60% of all PCOS patients are with modest up to exagerated overweight and that most of these patients show a modest up to an exagerated hyperinsulinism in response to the standard oral glucose tollerance test (OGTT). This reduced insulin sensitivity can be modified by a specific attention to life style, including not only a diet but also certain degree of physical activity. However, a specific effect on hyperinsulinemia can be achieved using glucose sensitizer drugs, such as metformin, so that to reduce the negative modulation exerted by hyperinsulinemia on the reproductive axis as well as on neuroendocrine control of reproduction with relevant effects also on adrenal function and neurosteroid production. Also specific integrative compounds have been proposed in recent years to counteract insulin resistance: myo-inositol (MYO) and d-chiro-inositol (DCI). These 2 compounds are tightly linked one to the other since MYO is transformed by an epimerase in DCI, having each tissue its own conversion rate, likely due to the specific needs for the two different molecules. In general both these compounds works as specific modulators of the intra cellular second messanger activated by the insulin linkage with its own membrane receptor. It remains clear that only the combination of life-style (diet & physical exercise) with one of the above mentioned treatments is able to solve the metabolic/endocrine impairment of overweight/obese PCOS.

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References

  1. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic-ovary syndrome. Fertil Steril 81:19–25

    Google Scholar 

  2. Zawadski JK, Dunaif A (1992) Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltien FP, Merriam GR (eds) Polycystic ovary syndrome. Blackwell, Boston, pp 337–384

    Google Scholar 

  3. Azziz R, Carmina E, Dewailly D, Androgen Excess Society et al (2006) Position statement: criteria for defining polycystic ovary syndrome: an androgen excess society guideline. J Clin Endocrinol Metab 91:4237–4245

    Article  CAS  PubMed  Google Scholar 

  4. Carmina E, Lobo RA (1999) Polycystic ovary syndrome: arguably the most common endocrinopathy is associated with significant morbidity in women. J Clin Endocrinol Metab 84:1897–1899

    Article  CAS  PubMed  Google Scholar 

  5. Zboroeski JV, Cauley JA, Talbott EO et al (2000) Bone mineral density, androgens, and the polycystic ovary: the complex and controversial issue of androgenic influence in female bone. J Clin Endocrinol Metab 85:3496–3506

    Article  Google Scholar 

  6. Carmina E, Lobo RA (2004) Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome. Fertil Steril 82:661–665

    Article  PubMed  Google Scholar 

  7. Catalano PM, Presley L, Minium J, Hauguel-de Mouzon S (2009) Fetuses of obese mothers develop insulin resistance in utero. Diabetes Care 32:1076–1080

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Kebapcilar L, Taner CE, Kepapcilar AG, Sari I (2009) High mean platelet volume, low grade systemic coagulation and fibrinolytic cavitation are associated with androgen and insulin levels in polycystic ovary syndrome. Arch Gynecol Obstet 280:187–193

    Article  CAS  PubMed  Google Scholar 

  9. Talbott EO, Guzick DS, Sutton Tyrell K, McHugh Pemu KP, Zborowski JV, Remsberg KE, Kuller LH (2000) Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler Thromb Vasc Biol 20:2014–2421

    Article  Google Scholar 

  10. Oral B, Mermi B, Dilek M, Alanoglu G, Sutcu R (2009) Thrombin activatable fibrinolysis inhibitor and other hemostatic parameters in patients with polycystic ovary syndrome. Gynecol Endocrinol 25:110–116

    Article  CAS  PubMed  Google Scholar 

  11. Dahlgren E, Janson PO, Johansson S, Lapidus L, Lindstedt G, Tengborn L (1994) Hemostatic and metabolic variables in women with polycystic ovary syndrome. Fertil Steril 61:455–460

    CAS  PubMed  Google Scholar 

  12. Genazzani AD, Santagni S, Ricchieri F, Campedelli A, Rattighieri E, Chierchia E, Marini G, Despini G, Prati A, Simoncini T (2014) Myo-inositol modulates insulin and luteinizing hormone secretion in normal weight patients with polycystic ovary syndrome. J Obstet Gynaecol Res. doi:10.1111/jog.12319

    PubMed  Google Scholar 

  13. Repaci A, Gambineri A, Pasquali R (2011) The role of low-grade inflammation in the polycystic ovary syndrome. Mol Cell Endocrinol 335:30–41

    Article  CAS  PubMed  Google Scholar 

  14. Heijnen EM, Eijkemans MJ, Hughes EG, Laven JS, Macklon NS, Fausen BC (2006) A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndrome. Hum Reprod Update 12:13–21

    Article  CAS  PubMed  Google Scholar 

  15. Vlaisavljevic V, Kovac V, Sajko MC (2009) Impact of insulin resistance on the developmental potential of immature oocytes retrieved from human chorionic gonadotropin-primed women with polycystic ovary syndrome undergoing in vitro maturation. Fertil Steril 91:957–959

    Article  CAS  PubMed  Google Scholar 

  16. Franks S, Stark J, Hardy K (2008) Follicle dynamics and anovulation in polycystic ovary syndrome. Hum Reprod Update 14:367–378

    Article  CAS  PubMed  Google Scholar 

  17. Wang TH, Chang CL, Wu HM, Chiu YM, Chen CK, Wang HS (2006) Insulin like growth factor II, IGF- binding protein 3, and IGFBP 4 in follicular fluid are associated with oocyte maturation and embryo development. Fertil Steril 67:1846–1852

    Google Scholar 

  18. Guglielmo MC, Ricci G, Catizone A, Barbieri M, Gardieri M, Stefanini M et al (2011) The effect of hepatocyte growth factor on the initial stages of mouse follicle development. J Cell Physiol 226:520–529

    Article  CAS  PubMed  Google Scholar 

  19. Uzumcu M, Pan Z, Chu Y, Kuhn PE, Zachow R (2006) Immunolocalization of the hepatocyte growth factor system in the rat ovary and the anti apoptotic effect of HGF in rat ovarian granulose cells in vitro. Reproduction 132:291–299

    Article  CAS  PubMed  Google Scholar 

  20. Nur Sahin MD, Asli Toylu MD, Bulent Gulekli MD et al (2013) The levels of hepatocyte growth factor in serum and follicular fluid and the expression of c-Met in granulosa cells in patients with polycystic ovary syndrome. Fertil Steril 99:264–270

    Article  PubMed  Google Scholar 

  21. Palomba S, Falbo A, Russo T, Tolino A, Orio F, Zullo F (2010) Pregnancy in women with polycystic ovary syndrome: the effect of different phenotypes and features on obstetric and neonatal outcomes. Fertil Steril 94:1805–1811

    Article  PubMed  Google Scholar 

  22. Palomba S, Falbo A, Zullo F, Orio F (2009) Evidence based and potential benefits of metformin in the polycystic ovary syndrome: a comprehensive review. Endocr Rev 30:1–50

    Article  CAS  PubMed  Google Scholar 

  23. Deligeoroglou E, Kouskouti C, Christopoulos P (2009) The role of genes in the polycystic ovary syndrome: predisposition and mechanism. Gynecol Endocrinol 25:603–609

    Article  CAS  PubMed  Google Scholar 

  24. Ehrmann DA (2005) Polycystic ovary syndrome. N Engl J Med 352:1223–1236

    Article  CAS  PubMed  Google Scholar 

  25. Kiddy DS, Sharp PS, White DM et al (1990) Differences in clinical and endocrine features between obese and non obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases. Clin Endocrinol (Oxf) 32(2):213–220

    Article  CAS  Google Scholar 

  26. Sebire NJ, Jolly M, Harris JP (2001) Maternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London. Int J Obes Relat Metab Discord 25(8):1175–1182

    Article  CAS  Google Scholar 

  27. Pasquali R, Casimirri F, Venturoli S et al (1994) Body fat distribution has weight independent effects on clinical, hormonal and metabolic features of women with polycystic ovary syndrome. Metabolism 43(6):706–713

    Article  CAS  PubMed  Google Scholar 

  28. Dunaif A (1997) Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 18(6):774–800

    CAS  PubMed  Google Scholar 

  29. Kahn BB, Flier JS (2000) Obesity and insulin resistance. J Clin Invest 106:473–481

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Monzillo LU, Hamby O (2003) Evaluation of insulin sensitivity in clinical practice and in research settings. Nutr Rev 61(12):397–412

    Article  PubMed  Google Scholar 

  31. Dunaif A, Segal KR, Futterweit W et al (1989) Profound peripheral insulin resistance, independent of obesity in polycystic ovary syndrome. Diabetes 38(9):1165–1174

    Article  CAS  PubMed  Google Scholar 

  32. Ciampelli M, Fulghesu AM, Cucinelli F et al (1999) Impact of insulin and body mass index on metabolic and endocrine variables in polycystic ovary syndrome. Metabolism 48(2):167–172

    Article  CAS  PubMed  Google Scholar 

  33. Legro RS, Kunselman AR, Dodson WC (1999) Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 84(1):165–169

    CAS  PubMed  Google Scholar 

  34. Qiao Q, Tuomilehto J (2001) Diagnostic criteria of glucose intolerance and mortality. Minerva Med 92(2):113–119

    CAS  PubMed  Google Scholar 

  35. Van Pelt RE, Jankowski CM, Gozansky WS (2005) Lower body adiposity and metabolic protection in postmenopausal women. J Clin Endocrinol Metab 90(8):4573–4578

    Article  PubMed Central  PubMed  Google Scholar 

  36. Frayn KN (2000) Visceral fat and insulin resistance- causative or correlative? Br J Nutr 83(suppl):S71–S77

    CAS  PubMed  Google Scholar 

  37. Havel PJ (2004) Update on adipocyte hormones: regulation of energy balance and carbohydrate/lipid metabolism. Diabetes 83(suppl):S143–S151

    Article  Google Scholar 

  38. Giorgino F, Laviola L, Eriksson JW (2005) Regional differences of insulin action in adipose tissues: insights from in vivo and in vitro studies. Acta Physiol Scand 183(1):13–30

    Article  CAS  PubMed  Google Scholar 

  39. Rebuffe Scrive M, Cullberg G, Lundberg PA (1989) Anthropometric variables and metabolism in polycystic ovarian disease. Horm Metab Res 21(7):391–397

    Article  CAS  PubMed  Google Scholar 

  40. Norman RJ, Masters SC, Hague W (1995) Metabolic approaches to the subclassification of polycystic ovary syndrome. Fertil Steril 63(2):329–335

    CAS  PubMed  Google Scholar 

  41. Puder JJ, Varga S, Kraenzlin M (2005) Central fat excess in polycystic ovary syndrome: relation to low grade inflammation and insulin resistance. J Clin Endocrinol Metab 90(11):6014–6021

    Article  CAS  PubMed  Google Scholar 

  42. Eckel RH, Alberti KG, Grundy SM, Zimmet PZ (2010) The metabolic syndrome. Lancet 375(9710):181–183

    Article  PubMed  Google Scholar 

  43. Ehrmann DA, Lijenquist DR, Kasza K, Azziz R, Legro RS, Ghazzi MN, PCOS/Troglitazone Study Group (2006) Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome (PCOS). J Clin Endocrinol Metab 91:48–53

    Article  CAS  PubMed  Google Scholar 

  44. International Diabetes Federation (2006) The International Diabetes Federation consensus worldwide definition of the metabolic syndrome. International Diabetes Federation, Brussels

    Google Scholar 

  45. Lusher TF, Richard V, Tshudi M, Yang ZH, Boulanger C (1990) Endothelial control of vascular tone in large and small coronary arteries. J Am Coll Cardiol 15:519–527

    Article  Google Scholar 

  46. Muniyappa R, Montagnani M, Koh KK, Quon MJ (2007) Cardiovascular actions of insulin. Endocr Rev 28:463–491

    Article  CAS  PubMed  Google Scholar 

  47. Carmina E (2009) Cardiovascular risk and events in polycystic ovary syndrome. Climacteric 12(suppl 1):22–25

    Article  PubMed  Google Scholar 

  48. Hirschberg AL (2009) Polycystic ovary syndrome, obesity and reproductive implications. Womens Health 5:529–540

    Google Scholar 

  49. Genazzani AD, Petraglia F, Pianazzi F, Volpogni C, Genazzani AR (1993) The concomitant release of androstenedione with cortisol and luteinizing hormone pulsatile releases distinguishes adrenal from ovarian hyperandrogenism. Gynecol Endocrinol 7:33–41

    Article  CAS  PubMed  Google Scholar 

  50. Vrbikova J, Hainer V (2009) Obesity and polycystic ovary syndrome. Obes Facts 2:26–35

    Article  PubMed  Google Scholar 

  51. Plouffe L (2000) Disorders of excessive hair growth in the adolescent. Obstet Gynecol Clin North Am 27:79–99

    Article  PubMed  Google Scholar 

  52. Chittenden BG, Fullerton G, Maheshwari A, Bhattacharya S (2009) Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review. Reprod Biomed Online 19:398–405

    Article  CAS  PubMed  Google Scholar 

  53. Arroyo A, Laughlin GA, Morales AJ, Yen SS (1997) Inappropriate gonadotropin secretion in polycystic ovary syndrome: influence of adiposity. J Clin Endocrinol Metab 82(11):3728–3733

    CAS  PubMed  Google Scholar 

  54. Barbieri RL (2000) The role of adipose tissue and hyperinsulinemia in the development of hyperandrogenism in women. In: Frisch RE (ed) Adipose tissue and reproduction. Karger, Basel, pp 42–57

    Google Scholar 

  55. Conway GS, Jacobs HS, Holly JM, Wass JA (1990) Effects of LH, insulin, insulin like growth factor I and insulin like growth factor small binding protein I in the polycystic ovary syndrome. Clin Endocrinol (Oxf) 33:593–603

    Article  CAS  Google Scholar 

  56. Dunaif A, Givens JR, Haseltine F et al (1992) The polycystic ovary syndrome. Blackwell, Boston

    Google Scholar 

  57. Andersen P, Selieflot I, Abdel Noor M (2001) Increased insulin sensitivity and fibrinolytic capacity after dietary intervention or metformin. N Engl J Med 344(18):1343–1350

    Article  Google Scholar 

  58. Pasquali R, Gambineri A, Biscotti D et al (2000) Effect of long term treatment with metformin added to hypocaloric diet on body composition, fat distribution and androgen and insulin levels in abdominally obese women with or without the polycystic ovary syndrome. J Clin Endocrinol Metab 85(8):2767–2774

    Article  CAS  PubMed  Google Scholar 

  59. Huber Buchholz MM, Carey DG, Norman RJ (1999) Restoration of reproductive potential by lifestyle modification in obese polycystic vary syndrome: role of insulin sensitivity and luteinizing hormone. J Clin Endocrinol Metab 84(4):1470–1474

    CAS  PubMed  Google Scholar 

  60. Pasquli R, Casimirri F, Colella P, Melchionda N (1989) Body fat distribution and weight loss in obese women. Am J Clin Nutr 49(19):185–187

    Google Scholar 

  61. Guzick DS, Wing R, Smith D (1994) Endocrine consequences of weight loss in obese, hyperandrogenic anovulatory women. Clin Endocrinol (Oxf) 61(4):598–604

    CAS  Google Scholar 

  62. Franks S, Kiddy D, Sharp P (1991) Obesity and polycystic ovary syndrome. Ann N Y Acad Sci 626:201–206

    Article  CAS  PubMed  Google Scholar 

  63. Holte J, Bergh T, Gennarelli G, Wide L (1994) The independent effects of polycystic ovary syndrome and obesity ion serum concentrations of gonadotropins and sex steroids in premenopausal women. Clin Endocrinol (Oxf) 41(4):473–481

    Article  CAS  Google Scholar 

  64. Pasquali R, Fabbri R, Venturoli S et al (1986) Effects of weight loss and antiandrogenic therapy on sex hormone blood levels and insulin resistance in obese patients with polycystic ovaries. Am J Obstet Gynecol 154(1):139–144

    Article  CAS  PubMed  Google Scholar 

  65. Kiddy DS, Hamilton Fairley D, Seppala M et al (1989) Diet induced changes in sex hormone binding globulin and free testosterone in women with normal or polycystic ovaries: correlation with serum insulin and insulin like growth factor I. Clin Endocrinol (Oxf) 31(6):757–763

    Article  CAS  Google Scholar 

  66. Kiddy DS, Hamilton Fairley D, Bush A et al (1992) Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 36(1):105–111

    Article  CAS  Google Scholar 

  67. Van Dam EW, Roelfsema F, Veldhuis JD (2002) Increase in daily LH secretion in response to short term calorie restriction in obese women with PCOS. Am J Physiol Endocrinol Metab 282(4):E865–E872

    Article  PubMed  Google Scholar 

  68. Tang T, Glanville J, Hayden CJ (2006) Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome. A randomized placebo controlled double blind multicentre study. Hum Reprod 21:80–89

    Article  PubMed  Google Scholar 

  69. Kitabchi AE, Temprosa M, Knowler WC (2005) Role of insulin secretion and sensitivity in the evolution of type 2 diabetes in the diabetes prevention program: effects of lifestyle intervention and metformin. Diabetes 54:2404–2414

    Article  PubMed  Google Scholar 

  70. Nieuwenhuis Ruifrok AE, Kuchenbecker WK, Hoek A, Middleton P, Norman RJ (2009) Insulin sensitizing drugs or weight loss in women of reproductive age who are overweight or obese; systematic review and meta analysis. Hum Reprod Update 15:57–68

    Article  CAS  PubMed  Google Scholar 

  71. La Marca A, Morgante G, Paglia T, Ciotta L, Cianci A, De Leo V (1999) Effects of metformin on adrenal steroidogenesis in women with polycystic ovary syndrome. Fertil Steril 72:985–989

    Article  PubMed  Google Scholar 

  72. Cosma M, Swiglo BA, Flynn DN et al (2008) Insulin sensitizers for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. J Clin Endocrinol Metabol 93:1135–1142

    Article  CAS  Google Scholar 

  73. Genazzani AD, Lanzoni C, Ricchieri F, Baraldi E, Csarosa E, Jasonni VM (2007) Metformin administration is more effective when non obese patients with polycystic ovary syndrome show both hyperandrogenism and hyperinsulinemia. Gynecol Endocrinol 23:146–152

    Article  CAS  PubMed  Google Scholar 

  74. Genazzani AD, Lanzoni C, Ricchieri F, Jasonni VM (2008) Myoinositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome. Gynecol Endocrinol 24:139–144

    Article  CAS  PubMed  Google Scholar 

  75. Baillargeon JP, Diamanti Kandarakis E, Ostlund RE, Apridonidze T, Iuorno MJ, Nestler JE (2006) Altered D-chiro-inositol urinary clearance in women with polycystic ovary syndrome. Diabetes Care 29:300–305

    Article  CAS  PubMed  Google Scholar 

  76. Baillargeon JP, Iuorno MJ, Jakubowicz DJ, Apridonidze T, He N, Nestler JE (2004) Metformin therapy increases insulin stimulated release of D-chiro-inositol containing inositolphosphoglycan mediator in women with polycystic ovary syndrome. J Clin Endocrinol Metabol 89:242–249

    Article  CAS  Google Scholar 

  77. Larner J (2002) D chiro-inositol, its functional role in insulin action and its deficit in insulin resistance. Int J Exp Diabetes Res 3:47–60

    Article  PubMed Central  PubMed  Google Scholar 

  78. Nestler JE, Jakubowicz DJ, Reamer P, Gunn RD, Allan G (1999) Ovulatory and metabolic effects of D chiro inositol in the polycystic ovary syndrome. N Engl J Med 340:1314–1320

    Article  CAS  PubMed  Google Scholar 

  79. Gerli S, Mignosa M, Di Renzo GC (2003) Effects of inositol on ovarian function and metabolic factors in women with PCOS: a randomized double blind placebo controlled trial. Eur Rev Med Pharmacol Sci 7:151–159

    CAS  PubMed  Google Scholar 

  80. Chiu TTY, Rogers MS, Law ELK, Briton Jones CM, Cheung LP, Haines CJ (2002) Follicular fluid and serum concentrations of myo-inositol in patients undergoing IVF: relationship with oocyte quality. Hum Reprod 6:1591–1596

    Article  Google Scholar 

  81. Genazzani AD, Ricchieri F, Prati A, Santagni S, Chierchia E, Rattichieri E, Campedelli A, Simoncini T, Artini PG (2012) Differential insulin response to myoinositol administration in obese PCOS patients. Gynecol Endocrinol 28:969–973

    Article  CAS  PubMed  Google Scholar 

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  1. Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Modena, Italy

    Alessandro D. Genazzani, Susanna Santagni, Erika Rattighieri, Elisa Chierchia, Giulia Despini, Alessia Prati & Federica Ricchieri

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  1. Department of Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands

    Bart C. J. M. Fauser

  2. International Society of Gynecological Endocrinology, Pisa, Italy

    Andrea R. Genazzani

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Genazzani, A.D. et al. (2015). PCOS and Insulin Resistance (IR): From Lifestyle to Insulin Sensitizers. In: Fauser, B.C.J.M., Genazzani, A.R. (eds) Frontiers in Gynecological Endocrinology. ISGE Series. Springer, Cham. https://doi.org/10.1007/978-3-319-09662-9_2

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