Insulin resistance and polycystic ovary syndrome: the current state of the problem

Abstract

Polycystic ovary syndrome (PCOS) is one of the most common pathologies found in women of reproductive age. The article presents a modern view on the problem of the development of PCOS. Insulin resistance (IR) plays an important role in the pathogenesis of this syndrome. An increased concentration of insulin leads to disturbances in the hypothalamic-pituitary-ovarian system, resulting in hyperandrogenemia and anovulation. A number of studies indicate the emergence of a vicious circle between hyperandrogenemia and hyperinsulinemia, which aggravate each other through reciprocal mechanisms. One of the links in the pathogenesis of PCOS development may be oxidative stress, which is associated with damage to cell membranes, disruption of intracellular signaling, which leads to meta-inflammation and subsequent insulin resistance. Studies demonstrating the connection between the intestinal microbiota and insulin resistance deserve special attention. However, there is no clear understanding of what is primary in the pathogenesis – an imbalance of microorganisms in the intestine, which affects the development of PCOS, or, on the contrary, PCOS contributes to the occurrence of an imbalance of intestinal microbiota. Understanding the holistic picture of the mechanism of development of PCOS allows us to identify several vectors of pathogenetic therapy for this disease, among which an important place is occupied by the correction of meta-inflammation, insulin resistance, oxidative stress and normalization of the balance of intestinal microbiota. The presented review demonstrates the validity of these therapeutic priorities.