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Toward Adolescent Prevention of Adult Anovulation in Polycystic Ovary Syndrome

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Book cover Impact of Polycystic Ovary, Metabolic Syndrome and Obesity on Women Health

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Abstract

Adolescent polycystic ovary syndrome (PCOS) is most often the outcome of a mismatch between an energy-sparing (epi)genetic background and a relatively energy-rich environment. This mismatch results in a sustained requirement to store more fat than is safely feasible in subcutaneous adipose tissue, and the excess of fat ends up being stored in ectopic depots, notably in the liver and viscera (= hepato-visceral or central fat). In adolescent girls with PCOS, prolonged treatment with an estro-progestagen contraceptive reduces the androgen excess but not the underpinning PCOS drive (exerted by ectopic fat excess and insulin resistance) so that, upon discontinuation of such prolonged treatment, the young women rebound swiftly into androgen excess and oligo-anovulation, thus into adult PCOS.

A low-dose combination treatment with spironolactone, pioglitazone, and metformin (SPIOMET) in adolescent girls with PCOS has the capacity to reduce the ectopic adiposity and insulin resistance (without weight loss) and to normalize the entire PCOS phenotype including ovulation rate, and could thus become an adjunct to lifestyle measures in a young age range, when contraceptive measures may not yet be needed.

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Acknowledgments

The authors declare no conflict of interest.

This study was supported by the Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III, and the Fondo Europeo de Desarrollo Regional (FEDER) (PI15/01078).

Author information

Authors and Affiliations

  1. Department of Development & Regeneration, University of Leuven, Leuven, Belgium

    Francis de Zegher

  2. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain

    Lourdes Ibáñez

  3. Endocrinology Department, Research Institute Sant Joan de Déu, University of Barcelona, Barcelona, Spain

    Lourdes Ibáñez

Authors
  1. Francis de Zegher
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  2. Lourdes Ibáñez
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Corresponding author

Correspondence to Lourdes Ibáñez .

Editor information

Editors and Affiliations

  1. International Society of Gynecological Endocrinology, Pisa, Italy

    Andrea R. Genazzani

  2. Endocrinology Department, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain

    Lourdes Ibáñez

  3. Department of Endocrinology, Diabetology, Wrocław Medical University, Wroclaw, Poland

    Andrzej Milewicz

  4. Obstetrics and Gynecology, Gynaecworld, Mumbai, India

    Duru Shah

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de Zegher, F., Ibáñez, L. (2021). Toward Adolescent Prevention of Adult Anovulation in Polycystic Ovary Syndrome. In: Genazzani, A.R., Ibáñez, L., Milewicz, A., Shah, D. (eds) Impact of Polycystic Ovary, Metabolic Syndrome and Obesity on Women Health. ISGE Series. Springer, Cham. https://doi.org/10.1007/978-3-030-63650-0_3

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  • DOI: https://doi.org/10.1007/978-3-030-63650-0_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-63649-4

  • Online ISBN: 978-3-030-63650-0

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