Ovarian hypertension: Polycystic ovary syndrome

Endocrinology and Metabolism Clinics of North America

Volumn 40, Issue 2, 2011, Pages 433-449

  Bentley Lewis, Rhonda ^a   Seely, Ellen ^b   Dunaif, Andrea ^c  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b BRIGHAM AND WOMEN S HOSPITAL   (United States)

^c NORTHWESTERN UNIVERSITY   (United States)

Author keywords

Hyperandrogenism; Hypertension; Insulin; Obesity; Polycystic ovary syndrome

Indexed keywords

ANTIANDROGEN; CYPROTERONE ACETATE; DESOGESTREL; DROSPIRENONE; DROSPIRENONE PLUS ETHINYLESTRADIOL; METFORMIN; ORAL CONTRACEPTIVE AGENT; SPIRONOLACTONE;

ADRENERGIC SYSTEM; CARDIOVASCULAR RISK; DISEASE ASSOCIATION; DYSLIPIDEMIA; FEMALE; GENETIC SUSCEPTIBILITY; HUMAN; HYPERANDROGENISM; HYPERTENSION; INSULIN RESISTANCE; LIFESTYLE MODIFICATION; METABOLIC SYNDROME X; OBESITY; OVARY POLYCYSTIC DISEASE; PANCREAS ISLET BETA CELL; PANCREAS ISLET DISEASE; PATHOPHYSIOLOGY; PREGNANCY; PREVALENCE; PRIORITY JOURNAL; REVIEW;

CARDIOVASCULAR DISEASES; FEMALE; HUMANS; HYPERTENSION; POLYCYSTIC OVARY SYNDROME; PREHYPERTENSION; PREVALENCE; RISK FACTORS;

EID: 79955714464     PISSN: 08898529     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ecl.2011.01.009     Document Type: Review

References (118)

1. Stein I.F., Leventhal M.L. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935, 19:181-191.
2. Burghen G.A., Givens J.R., Kitabchi A.E. Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. J Clin Endocrinol Metab 1980, 50(1):113-116.
3. Dunaif A., Graf M., Mandeli J., et al. Characterization of groups of hyperandrogenic women with acanthosis nigricans, impaired glucose tolerance, and/or hyperinsulinemia. J Clin Endocrinol Metab 1987, 65(3):499-507.
4. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997, 18(6):774-800.
5. Ehrmann D.A. Polycystic ovary syndrome. N Engl J Med 2005, 352(12):1223-1236.
6. Polson D.W., Adams J., Wadsworth J., et al. Polycystic ovaries-a common finding in normal women. Lancet 1988, 1(8590):870-872.
7. Legro R.S., Chiu P., Kunselman A.R., et al. Polycystic ovaries are common in women with hyperandrogenic chronic anovulation but do not predict metabolic or reproductive phenotype. J Clin Endocrinol Metab 2005, 90(5):2571-2579.
8. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004, 81(1):19-25.
9. Robinson S., Kiddy D., Gelding S.V., et al. The relationship of insulin insensitivity to menstrual pattern in women with hyperandrogenism and polycystic ovaries. Clin Endocrinol (Oxf) 1993, 39(3):351-355.
10. Adams J.M., Taylor A.E., Crowley W.F., et al. Polycystic ovarian morphology with regular ovulatory cycles: insights into the pathophysiology of polycystic ovarian syndrome. J Clin Endocrinol Metab 2004, 89(9):4343-4350.
11. Azziz R., Carmina E., Dewailly D., et al. Criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 2006, 91(11):4237-4245.
12. Carmina E., Lobo R.A. Polycystic ovary syndrome (PCOS): arguably the most common endocrinopathy is associated with significant morbidity in women. J Clin Endocrinol Metab 1999, 84:1897-1899.
13. March W.A., Moore V.M., Willson K.J., et al. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010, 25(2):544-551.
14. Azziz R., Woods K.S., Reyna R., et al. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004, 89(6):2745-2749.
15. Asunción M., Calvo R.M., San Millán J.L., et al. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000, 85(7):2434-2438.
16. Diamanti-Kandarakis E., Kouli C.R., Bergiele A.T., et al. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab 1999, 84(11):4006-4011.
17. Moran C., Tena G., Moran S., et al. Prevalence of polycystic ovary syndrome and related disorders in Mexican women. Gynecol Obstet Invest 2010, 69(4):274-280.
18. Knochenhauer E.S., Key T.J., Kahsar-Miller M., et al. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab 1998, 83(9):3078-3082.
19. Lo J.C., Feigenbaum S.L., Yang J., et al. Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. J Clin Endocrinol Metab 2006, 91(4):1357-1363.
20. Marshall J.C., Eagleson C.A. Neuroendocrine aspects of polycystic ovary syndrome. Endocrinol Metab Clin North Am 1999, 28:295-324.
21. Eagleson C.A., Gingrich M.B., Pastor C.L., et al. Polycystic ovarian syndrome: evidence that flutamide restores sensitivity of the gonadotropin-releasing hormone pulse generator to inhibition by estradiol and progesterone. J Clin Endocrinol Metab 2000, 85(11):4047-4052.
22. Franks S. Polycystic ovary syndrome. Trends Endocrinol Metab 1989, 1(2):60-63.
23. Nelson V.L., Qin K.N., Rosenfield R.L., et al. The biochemical basis for increased testosterone production in theca cells propagated from patients with polycystic ovary syndrome. J Clin Endocrinol Metab 2001, 86(12):5925-5933.
24. Reid R.L., Leopold G.R., Yen S.S. Induction of ovulation and pregnancy with pulsatile luteinizing hormone releasing factor: dosage and mode of delivery. Fertil Steril 1981, 36(5):553-559.
25. Legro R.S., Driscoll D., Strauss J.F., et al. Evidence for a genetic basis for hyperandrogenemia in polycystic ovary syndrome. Proc Natl Acad Sci U S A 1998, 95(25):14956-14960.
26. Wickenheisser J.K., Quinn P.G., Nelson V.L., et al. Differential activity of the cytochrome P450 17alpha-hydroxylase and steroidogenic acute regulatory protein gene promoters in normal and polycystic ovary syndrome theca cells. J Clin Endocrinol Metab 2000, 85(6):2304-2311.
27. Dunaif A. Insulin action in the polycystic ovary syndrome. Endocrinol Metab Clin North Am 1999, 28:341-359.
28. Dunaif A., Wu X., Lee A., et al. Defects in insulin receptor signaling in vivo in the polycystic ovary syndrome (PCOS). Am J Physiol Endocrinol Metab 2001, 281(2):E392-E399.
29. Book C.B., Dunaif A. Selective insulin resistance in the polycystic ovary syndrome. J Clin Endocrinol Metab 1999, 84(9):3110-3116.
30. Ehrmann D.A., Sturis J., Byrne M.M., et al. Insulin secretory defects in polycystic ovary syndrome. Relationship to insulin sensitivity and family history of non-insulin-dependent diabetes mellitus. J Clin Invest 1995, 96:520-527.
31. Legro R.S., Kunselman A.R., Dodson W.C., et al. 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 1999, 84(1):165-169.
32. Escobar-Morreale H.F., Botella-Carretero J.I., Alvarez-Blasco F., et al. The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery. J Clin Endocrinol Metab 2005, 90(12):6364-6369.
33. Laitinen J., Taponen S., Martikainen H., et al. Body size from birth to adulthood as a predictor of self-reported polycystic ovary syndrome symptoms. Int J Obes Relat Metab Disord 2003, 27(6):710-715.
34. Hoeger K.M. Obesity and lifestyle management in polycystic ovary syndrome. Clin Obstet Gynecol 2007, 50(1):277-294.
35. Grodstein F., Goldman M.B., Cramer D.W. Body mass index and ovulatory infertility. Epidemiology 1994, 5(2):247-250.
36. Legro R.S., Kunselman A.R., Demers L., et al. Elevated dehydroepiandrosterone sulfate levels as the reproductive phenotype in the brothers of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2002, 87(5):2134-2138.
37. Legro R.S., Bentley-Lewis R., Driscoll D., et al. Insulin resistance in the sisters of women with polycystic ovary syndrome: association with hyperandrogenemia rather than menstrual irregularity. J Clin Endocrinol Metab 2002, 87(5):2128-2133.
38. Urbanek M., Legro R.S., Driscoll D.A., et al. Thirty-seven candidate genes for polycystic ovary syndrome: strongest evidence for linkage is with follistatin. Proc Natl Acad Sci U S A 1999, 96(15):8573-8578.
39. Urbanek M., Wu X., Vickery K.R., et al. Allelic variants of the follistatin gene in polycystic ovary syndrome. J Clin Endocrinol Metab 2000, 85(12):4455-4461.
40. Urbanek M., Sam S., Legro R.S., et al. Identification of a polycystic ovary syndrome susceptibility variant in fibrillin-3 and association with a metabolic phenotype. J Clin Endocrinol Metab 2007, 92(11):4191-4198.
41. Ewens K.G., Stewart D.R., Ankener W., et al. Family-based analysis of candidate genes for polycystic ovary syndrome. J Clin Endocrinol Metab 2010, 95(5):2306-2315.
42. Legro R.S. Polycystic ovary syndrome and cardiovascular disease: a premature association?. Endocr Rev 2003, 24(3):302-312.
43. Solomon C.G., Hu F.B., Dunaif A., et al. Menstrual cycle irregularity and risk for future cardiovascular disease. J Clin Endocrinol Metab 2002, 87(5):2013-2017.
44. National Cholesterol Education Program (NCEP) Expert Panel on Detection E and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002, 106:3143-3421.
45. Grundy S.M., Cleeman J.I., Daniels S.R., et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation 2005, 112(17):2735-2752.
46. Einhorn D., Reaven G.M., Cobin R.H., et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract 2003, 9(3):237-252.
47. International Diabetes Federation Worldwide definition of the metabolic syndrome Available at:, Accessed March 7, 2011. http://www.idf.org/webdata/docs/MetS_def_update2006.pdf.
48. Balkau B., Charles M.A. Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med 1999, 16:442-443.
49. Alberti K.G., Zimmet P.Z. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998, 15:539-553.
50. Essah P.A., Nestler J.E. Metabolic syndrome in women with polycystic ovary syndrome. Fertil Steril 2006, 86:S18-S19.
51. Sam S., Legro R.S., Bentley-Lewis R., et al. Dyslipidemia and metabolic syndrome in the sisters of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005, 90(8):4797-4802.
52. Bentley-Lewis R., Koruda K., Seely E.W. The metabolic syndrome in women. Nat Clin Pract Endocrinol Metab 2007, 3(10):696-704.
53. Legato M.J. Dyslipidemia, gender, and the role of high-density lipoprotein cholesterol: implications for therapy. Am J Cardiol 2000, 86(12A):15L-18L.
54. Valkenburg O., Steegers-Theunissen R.P., Smedts H.P., et al. A more atherogenic serum lipoprotein profile is present in women with polycystic ovary syndrome: a case-control study. J Clin Endocrinol Metab 2008, 93(2):470-476.
55. Carmina E. Cardiovascular risk and events in polycystic ovary syndrome. Climacteric 2009, 12(Suppl 1):22-25.
56. Conway G.S., Agrawal R., Betteridge D.J., et al. Risk factors for coronary artery disease in lean and obese women with the polycystic ovary syndrome. Clin Endocrinol (Oxf) 1992, 37(2):119-125.
57. Talbott E., Clerici A., Berga S.L., et al. Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study. J Clin Epidemiol 1998, 51(5):415-422.
58. Vrbíková J., Cífková R., Jirkovská A., et al. Cardiovascular risk factors in young Czech females with polycystic ovary syndrome. Hum Reprod 2003, 18(5):980-984.
59. Elting M.W., Korsen T.J., Bezemer P.D., et al. Prevalence of diabetes mellitus, hypertension and cardiac complaints in a follow-up study of a Dutch PCOS population. Hum Reprod 2001, 16(3):556-560.
60. Holte J., Gennarelli G., Berne C., et al. Elevated ambulatory day-time blood pressure in women with polycystic ovary syndrome: a sign of a pre-hypertensive state?. Hum Reprod 1996, 11(1):23-28.
61. Orbetzova M.M., Shigarminova R.G., Genchev G.G., et al. Role of 24-hour monitoring in assessing blood pressure changes in polycystic ovary syndrome. Folia Med (Plovdiv) 2003, 45(3):21-25.
62. Wild S., Pierpoint T., Jacobs H., et al. Long-term consequences of polycystic ovary syndrome: results of a 31 year follow-up study. Hum Fertil (Camb) 2000, 3(2):101-105.
63. Dahlgren E., Johansson S., Lindstedt G., et al. Women with polycystic ovary syndrome wedge resected in 1956 to 1965: a long-term follow-up focusing on natural history and circulating hormones. Fertil Steril 1992, 57(3):505-513.
64. Farquhar C., Lilford R.J., Marjoribanks J., et al. Laparoscopic 'drilling' by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev 2007, 3. CD001122.
65. Buttram V.C., Vaquero C. Post-ovarian wedge resection adhesive disease. Fertil Steril 1975, 26:874-876.
66. Barcellos C.R., Rocha M.P., Hayashida S.A., et al. Impact of body mass index on blood pressure levels in patients with polycystic ovary syndrome. Arq Bras Endocrinol Metabol 2007, 51(7):1104-1109.
67. Arslanian S.A., Lewy V.D., Danadian K. Glucose intolerance in obese adolescents with polycystic ovary syndrome: roles of insulin resistance and beta-cell dysfunction and risk of cardiovascular disease. J Clin Endocrinol Metab 2001, 86(1):66-71.
68. Luque-Ramírez M., Alvarez-Blasco F., Mendieta-Azcona C., et al. Obesity is the major determinant of the abnormalities in blood pressure found in young women with the polycystic ovary syndrome. J Clin Endocrinol Metab 2007, 92(6):2141-2148.
69. Zimmermann S., Phillips R.A., Dunaif A., et al. Polycystic ovary syndrome: lack of hypertension despite profound insulin resistance. J Clin Endocrinol Metab 1992, 75(2):508-513.
70. Sampson M., Kong C., Patel A., et al. Ambulatory blood pressure profiles and plasminogen activator inhibitor (PAI-1) activity in lean women with and without the polycystic ovary syndrome. Clin Endocrinol (Oxf) 1996, 45(5):623-629.
71. Cibula D., Cífková R., Fanta M., et al. Increased risk of non-insulin dependent diabetes mellitus, arterial hypertension and coronary artery disease in perimenopausal women with a history of the polycystic ovary syndrome. Hum Reprod 2000, 15(4):785-789.
72. Meyer C., McGrath B.P., Teede H.J. Overweight women with polycystic ovary syndrome have evidence of subclinical cardiovascular disease. J Clin Endocrinol Metab 2005, 90(10):5711-5716.
73. Boomsma C.M., Fauser B.C., Macklon N.S. Pregnancy complications in women with polycystic ovary syndrome. Semin Reprod Med 2008, 26(1):72-84.
74. Ludwig M. Risk during pregnancy and birth after assisted reproductive technologies: an integral view of the problem. Semin Reprod Med 2005, 23(4):363-370.
75. Sun L.M., Walker M.C., Cao H.L., et al. Assisted reproductive technology and placenta-mediated adverse pregnancy outcomes. Obstet Gynecol 2009, 114(4):818-824.
76. Möhlig M., Spranger J., Osterhoff M., et al. The polycystic ovary syndrome per se is not associated with increased chronic inflammation. Eur J Endocrinol 2004, 150(4):525-532.
77. Escobar-Morreale H.F., Villuendas G., Botella-Carretero J.I., et al. Obesity, and not insulin resistance, is the major determinant of serum inflammatory cardiovascular risk markers in pre-menopausal women. Diabetologia 2003, 46(5):625-633.
78. Ketel I.J., Stehouwer C.D., Serné E.H., et al. Obese but not normal-weight women with polycystic ovary syndrome are characterized by metabolic and microvascular insulin resistance. J Clin Endocrinol Metab 2008, 93(9):3365-3372.
79. Ketel I.J., Stehouwer C.D., Henry R.M., et al. Greater arterial stiffness in polycystic ovary syndrome (PCOS) is an obesity-but not a PCOS-associated phenomenon. J Clin Endocrinol Metab 2010, 95(10):4566-4575.
80. Libby P., Okamoto Y., Rocha V.Z., et al. Inflammation in atherosclerosis: transition from theory to practice. Circ J 2010, 74(2):213-220.
81. Spranger J., Möhlig M., Wegewitz U., et al. Adiponectin is independently associated with insulin sensitivity in women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2004, 61(6):738-746.
82. Lindholm A., Bixo M., Eliasson M., et al. Tissue plasminogen activator and plasminogen activator inhibitor 1 in obese and lean patients with polycystic ovary syndrome. Gynecol Endocrinol 2010, 26(10):743-748.
83. Guzick D.S., Talbott E.O., Sutton-Tyrrell K., et al. Carotid atherosclerosis in women with polycystic ovary syndrome: initial results from a case-control study. Am J Obstet Gynecol 1996, 174:1224-1232.
84. Talbott E.O., Guzick D.S., Sutton-Tyrrell K., et al. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women. Arterioscler Thromb Vasc Biol 2000, 20:2414-2421.
85. Luque-Ramírez M., Mendieta-Azcona C., Alvarez-Blasco F., et al. Androgen excess is associated with the increased carotid intima-media thickness observed in young women with polycystic ovary syndrome. Hum Reprod 2007, 22(12):3197-3203.
86. Carmina E., Orio F., Palomba S., et al. Endothelial dysfunction in PCOS: role of obesity and adipose hormones. Am J Med 2006, 119(4):356.e1-356.e6.
87. Christian R.C., Dumesic D.A., Behrenbeck T., et al. Prevalence and predictors of coronary artery calcification in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003, 88:2562-2568.
88. Talbott E.O., Zborowski J.V., Rager J.R., et al. Evidence for an association between metabolic cardiovascular syndrome and coronary and aortic calcification among women with polycystic ovary syndrome. J Clin Endocrinol Metab 2004, 89:5454-5461.
89. Talbott E.O., Zborowski J., Rager J., et al. Is there an independent effect of polycystic ovary syndrome (PCOS) and menopause on the prevalence of subclinical atherosclerosis in middle aged women?. Vasc Health Risk Manag 2008, 4(2):453-462.
90. Norman R.J., Dewailly D., Legro R.S., et al. Polycystic ovary syndrome. Lancet 2007, 370(9588):685-697.
91. Chen M.J., Yang W.S., Yang J.H., et al. Relationship between androgen levels and blood pressure in young women with polycystic ovary syndrome. Hypertension 2007, 49(6):1442-1447.
92. Riccioni G. The effect of antihypertensive drugs on carotid intima media thickness: an up-to-date review. Curr Med Chem 2009, 16(8):988-996.
93. Zavaroni I., Coruzzi P., Bonini L., et al. Association between salt sensitivity and insulin concentrations in patients with hypertension. Am J Hypertens 1995, 8(8):855-858.
94. Resnick L.M. Cellular ions in hypertension, insulin resistance, obesity, and diabetes: a unifying theme. J Am Soc Nephrol 1992, 3(Suppl 4):S78-S85.
95. Lord J.M., Flight I.H., Norman R.J. Insulin-sensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome. Cochrane Database Syst Rev 2003, 3. CD003053.
96. Diamanti-Kandarakis E., Alexandraki K., Piperi C., et al. Effect of metformin administration on plasma advanced glycation end product levels in women with polycystic ovary syndrome. Metabolism 2007, 56(1):129-134.
97. Hattori Y., Suzuki M., Hattori S., et al. Vascular smooth muscle cell activation by glycated albumin (Amadori adducts). Hypertension 2002, 39(1):22-28.
98. Orio F., Palomba S., Cascella T., et al. Improvement in endothelial structure and function after metformin treatment in young normal-weight women with polycystic ovary syndrome: results of a 6-month study. J Clin Endocrinol Metab 2005, 90(11):6072-6076.
99. Kannel W.B. Fifty years of Framingham study contributions to understanding hypertension. J Hum Hypertens 2000, 14(2):83-90.
100. Cupisti S., Kajaia N., Dittrich R., et al. Body mass index and ovarian function are associated with endocrine and metabolic abnormalities in women with hyperandrogenic syndrome. Eur J Endocrinol 2008, 158(5):711-719.
101. Glintborg D., Henriksen J.E., Andersen M., et al. Prevalence of endocrine diseases and abnormal glucose tolerance tests in 340 Caucasian premenopausal women with hirsutism as the referral diagnosis. Fertil Steril 2004, 82(6):1570-1579.
102. Azziz R., Sanchez L.A., Knochenhauer E.S., et al. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab 2004, 89(2):453-462.
103. Sverrisdottir Y.B., Mogren T., Kataoka J., et al. Is polycystic ovary syndrome associated with high sympathetic nerve activity and size at birth?. Am J Physiol Endocrinol Metab 2008, 294:E576-E581.
104. Yildirir A., Aybar F., Kabakci G., et al. Heart rate variability in young women with polycystic ovary syndrome. Ann Noninvasive Electrocardiol 2006, 11(4):306-312.
105. Muniyappa R., Montagnani M., Koh K.K., et al. Cardiovascular actions of insulin. Endocr Rev 2007, 28(5):463-491.
106. Müller-Wieland D., Kotzka J., Knebel B., et al. Metabolic syndrome and hypertension: pathophysiology and molecular basis of insulin resistance. Basic Res Cardiol 1998, 93(Suppl 2):131-134.
107. Wild R.A., Carmina E., Diamanti-Kandarakis E., et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010, 95(5):2038-2049.
108. Battaglia C., Mancini F., Fabbri R., et al. Polycystic ovary syndrome and cardiovascular risk in young patients treated with drospirenone-ethinylestradiol or contraceptive vaginal ring. A prospective, randomized, pilot study. Fertil Steril 2010, 94(4):1417-1425.
109. Kriplani A., Periyasamy A.J., Agarwal N., et al. Effect of oral contraceptive containing ethinyl estradiol combined with drospirenone vs. desogestrel on clinical and biochemical parameters in patients with polycystic ovary syndrome. Contraception 2010, 82(2):139-146.
110. Fruzzetti F., Perini D., Lazzarini V., et al. Comparison of effects of 3 mg drospirenone plus 20 μg ethinyl estradiol alone or combined with metformin or cyproterone acetate on classic metabolic cardiovascular risk factors in nonobese women with polycystic ovary syndrome. Fertil Steril 2010, 94(5):1793-1798.
111. Guido M., Romualdi D., Giuliani M., et al. Drospirenone for the treatment of hirsute women with polycystic ovary syndrome: a clinical, endocrinological, metabolic pilot study. J Clin Endocrinol Metab 2004, 89(6):2817-2823.
112. Ober K.P., Hennessy J.F. Spironolactone therapy for hirsutism in a hyperandrogenic woman. Ann Intern Med 1978, 89:643-644.
113. Rathnayake D., Sinclair R. Innovative use of spironolactone as an antiandrogen in the treatment of female pattern hair loss. Dermatol Clin 2010, 28(3):611-618.
114. Christy N.A., Franks A.S., Cross L.B. Spironolactone for hirsutism in polycystic ovary syndrome. Ann Pharmacother 2005, 39(9):1517-1521.
115. Ganie M.A., Khurana M.L., Eunice M., et al. Comparison of efficacy of spironolactone with metformin in the management of polycystic ovary syndrome: an open-labeled study. J Clin Endocrinol Metab 2004, 89(6):2756-2762.
116. Armanini D., Castello R., Scaroni C., et al. Treatment of polycystic ovary syndrome with spironolactone plus licorice. Eur J Obstet Gynecol Reprod Biol 2007, 131(1):61-67.
117. Norman R.J., Davies M.J., Lord J., et al. The role of lifestyle modification in polycystic ovary syndrome. Trends Endocrinol Metab 2002, 13(6):251-257.
118. Eid G.M., Cottam D.R., Velcu L.M., et al. Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Surg Obes Relat Dis 2005, 1(2):77-80.