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Polycystiskt ovariesyndrom (PCOS)

Senast reviderad:
Sakkunnig:
Definition:
En heterogen sjukdom som karakteriseras av hyperandrogenism, anovulation/oligoovulation och polycystiska ovarier.
Förekomst:
Prevalensen är 6–16 % för kvinnor i fertil ålder.
Symtom:
Oregelbundna menstruationer, oligomenorré eller amenorré. Övervikt, hirsutism, akne och infertilitet kan förekomma.
Kliniska fynd:
Eventuellt övervikt, bukfetma och hirsutism.
Diagnostik:
Transvaginalt ultraljud. Blodprover för testosteron och SHBG, samt prover för att utesluta andra sjukdomar/hormonella störningar.
Behandling:
Behandlingen måste individualiseras efter kvinnans aktuella problem och symtom. 
  1. Ding T, HardimanPJ, Petersen I et al. The prevalenceofpolycysticovarysyndrome in reproductive-agedwomenofdifferentethnicity: a systematicreview and meta-analysis.Oncotarget. 2017 Jul 12;8(56):96351-96358. PMID: 29221211 PubMed  
  2. LegroRS, Driscoll D, StraussJF 3d et al. Evidence for a genetic basis for hyperandrogenemia in polycysticovarysyndrome. ProcNatlAcadSci U S A 1998;95:14956-60. PMID: 9843997 PubMed  
  3. RandevaHS, TanBK, Weickert MO, et al. Cardiometabolicaspectsofthepolycysticovarysyndrome. Endocr Rev. Oct 2012;33(5):812-841. PubMed  
  4. Hutchison SK, SteptoNK, Harrison CL, Moran LJ, StraussBJ, TeedeHJ. Effectsofexerciseon insulin resistance and bodycomposition in overweight and obesewomenwith and withoutpolycysticovarysyndrome. J ClinEndocrinolMetab. Jan 2011;96(1):E48-56. PMID: 20926534 PubMed  
  5. LegroRS. Obesity and PCOS: implications for diagnosis and treatment. SeminReprod Med. Dec 2012;30(6):496-506. pmid: 23074008 PubMed  
  6. Pinola P, Piltonen TT, Puurunen J, et al. Androgen ProfileThroughLife in WomenWithPolycysticOvarySyndrome: A Nordic Multicenter CollaborationStudy. J ClinEndocrinolMetab. Sep 2015;100(9):3400-3407. PubMed  
  7. RichardsonMR. Currentperspectives in polycysticovarysyndrome. AmFamPhysician 2003; 68: 697-704. PubMed  
  8. RotterdamESHRE/ASRM-sponsoredPCOSConsensus Workshop Group (2004). Revised 2003 consensusondiagnosticcriteria and long-term health risks relatedtopolycysticovarysyndrome (PCOS). Hum Reprod 2004;19(1):41-47. PubMed  
  9. Williams T, Mortada R, Porter S. Diagnosis and treatmentofpolycysticovarysyndrome. AmFamPhysician 2016; 94: 106-13. pmid: 27419327 PubMed  
  10. Dewailly D, LujanME, Carmina E, et al. Definition and significanceofpolycysticovarianmorphology: a taskforcereport from the Androgen Excess and PolycysticOvarySyndromeSociety. Hum ReprodUpdate. May-Jun 2014;20(3):334-352. pmid: 24345633 PubMed  
  11. Kristensen SL, Ramlau-HansenCH, Ernst E, et al. A verylarge proportion ofyoungDanishwomenhavepolycysticovaries: is a revision oftheRotterdamcriterianeeded? Hum Reprod. Dec 2010;25(12):3117-3122. PubMed  
  12. LoboRA. Priorities in polycysticovarysyndrome. MJA 2001; 174: 554-5. PubMed  
  13. Derksen J, Nagesser SK, MeindersAE, HaakHR, van de VeldeCJ. Identificationofvirilizingadrenaltumors in hirsutewomen. N Engl J Med 1994;331:968-73. PMID: 8084355 PubMed  
  14. Moran LJ, Hutchison SK, Norman RJ, TeedeHJ. Lifestylechanges in womenwithpolycysticovarysyndrome. CochraneDatabaseSyst Rev. 2011(7):CD007506. Cochrane (DOI)  
  15. Huber-Buchholz MM, CareyDG, Norman RJ. Restoration ofreproductive potential by lifestylemodification in obesepolycysticovarysyndrome: roleof insulin sensitivity and luteinizinghormone. J ClinEndocrinolMetab 1999;84:1470-4. PubMed  
  16. LegroRS. Ovulationinduction in polycysticovarysyndrome: Current options. Best Pract Res ClinObstetGynaecol 2016; Nov;37: 152-159. pmid:27866938 PubMed  
  17. LegroRS, BrzyskiRG, DiamondMPet al. Letrozoleversusclomiphene for infertility in thepolycysticovarysyndrome. N Engl J Med 2014; Jul 10;371(2): 119-29. pmid:25006718 PubMed  
  18. Franik S, Eltrop SM, Kremer JA, et al. Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2018 May 24;5:CD010287. doi: 10.1002/14651858.CD010287.pub3 DOI  
  19. Polycystisktovarialsyndrom (PCOS). Svensk Förening för Obstetrik och Gynekologi Arbets- och Referensgrupp för Endokrinologi. Rapport nr 58 2008. www.sfog.se  
  20. Begränsningar i användningen av cyproteron på grund av risk för meningeom. Nyheter 2020-02-19 www.lakemedelsverket.se  
  21. Moll E, Bossuyt PM, KorevaarJC, LambalkCB, van derVeen F. Effectofclomifenecitrate plus metformin and clomifenecitrate plus placebo oninductionofovulation in womenwithnewlydiagnosedpolycysticovarysyndrome: randomiseddouble blind clinicaltrial. BMJ 2006; 332: 1485. PMID: 16769748 PubMed  
  22. Al-Inany H, Johnson N. Drugs for anovulatoryinfertility in polycysticovarysyndrome. BMJ 2006; 332: 1461-2. PubMed  
  23. Nestler JE, JakubowiczDJ, EvansWS, Pasquali R. Effectsofmetforminonspontaneus and clomiphen-inducedovulation in thepolycysticovarysyndrome. N Engl J Med 1998; 338:1876-80. PMID: 9637806 PubMed  
  24. Lord JM, Flight IHK, Norman RJ. Metformin in polycysticovarysyndrome: systematicreview and meta-analysis. BMJ 2003; 327: 951-6. PubMed  
  25. Tang T, Lord JM, Norman RJ, et al. Insulin-sensitisingdrugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for womenwithpolycysticovarysyndrome, oligoamenorrhoea and subfertility. CochraneDatabaseSyst Rev 2009; CD003053. PMID: 19821299 PubMed  
  26. Spritzer PM, Lisboa KO, Mattiello S, Lhullier F. Spironolactone as a single agent for long-term therapyofhirsute patients. ClinEndocrinol 2000;52:587-94. PubMed  
  27. Frøssing S, Nylander M, Chabanova E, et al. Effect of liraglutide on ectopic fat in polycystic ovary syndrome: A randomized clinical trial. Diabetes Obes Metab 2017. pmid:28681988 PubMed  
  28. ClaytonWJ, Lipton M, Elford J, Rustin M, Sherr L. A randomizedcontrolledtrialof laser treatmentamonghirsutewomenwithpolycysticovarysyndrome. Br J Dermatol 2005; 152: 986-92. PubMed  
  29. EhrmannDA. Obesity and glucoseintolerance in androgen excess. In: Azziz R, Nestler JE, Dewailly D, eds. Androgen excess disorders in women. Philadelphia: Lippincott-Raven, 1997:705-12.
  30. Carmina E, LoboRA. Polycysticovarysyndrome (PCOS): arguablythemostcommonendocrinopathy is associatedwithsignificantmorbidity in women. J ClinEndocrinolMetab 1999; 84: 1897-9. PubMed  
  31. BirdsallMA, Farquhar CM, WhiteHD. Association betweenpolycysticovaries and extentofcoronaryarterydisease in womenhavingcardiaccatheterization. Ann Intern Med 1997;126:32-5. PubMed  
  32. EhrmannDA, Liljenquist DR et al. Prevalence and predictorsofthemetabolicsyndrome in womenwithpolycysticovarysyndrome. J ClinEndocrinolMetab 2006 ;91:48-53. PMID: 16249284. PubMed  
  33. Hardiman P, Pillay OS, Atiomo W. Polycysticovarysyndrome and endometrialcarcinoma. Lancet 2003; 361: 1810-12. PubMed  
  34. Hudecova M, Holte J, Olovsson M, Sundström Poromaa I. Long-term follow-up of patients with polycystic ovary syndrome: reproductive outcome and ovarian reserve. Hum Reprod. 2009 May;24(5):1176-83. PMID: 19168874 PubMed  
  35. Boomsma CM, EijkemansMJet al. A meta-analysisofpregnancyoutcomes in womenwithpolycysticovarysyndrome. Hum.reprod. Update 2006;12:673-83. PMID: 16891296 PubMed  
  36. LøvvikTS, Wikström AK, Neovius M, et al. Pregnancy and perinataloutcomes in womenwithpolycysticovarysyndrome and twinbirths: a population-basedcohortstudy. BJOG 2015. doi:10.1111/1471-0528.13339 PMID: 25761516 PubMed  
  • Barbro Larson, docent och specialist i gynekologi och obstetrik, Stockholm
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet