Güncel polikistik over sendromu değerlendirme ve yönetim rehberi doğrultusunda tanıdaki ‘yeniler’ ve ‘yineler’

Reprodüktif çağda %10-13’lere kadar yüksek oranlarda görülen Polikistik Over Sendromu (PKOS) önemli bir toplum sağlık sorunudur. Sendromun heterojen yapısı nedeniyle kimi hastada reprodüktif, kimi hastada metabolik bozukluklar ön plana çıkmakta ve tedavi modaliteleri kişiden kişiye ve uygulayıcı hekime hatta branşlara göre farklılık gösterebilmektedir. Halbuki PKOS olgularının tanı ve yönetiminde ideal olan uluslarası kabul görmüş tanı ve tedavi kriterlerini içeren ve bireysel farklılıkları gözardı etmeyen rehberlerin oluşturulmasıdır. Bir çok dernek ve kuruluşun kendi bakış açılarıyla tanımlamaya çalıştığı PKOS’un daha objektif ve detaylı tanımlanması amaçlanarak ‘European Society of Human Reproduction and Embriology’ (ESHRE) ve ‘American Society of Reproductive Medicine’ (ASRM) nin de ortaklık ettiği ‘2018 Uluslarası kanıta dayalı PKOS değerlendirme ve yönetim rehberi’ (2018 PKOS Rehberi) yakın tarihte yayınlanmıştır. Bu rehberde birçok “yeni” nokta belirtilirken, bazı eski bilgiler ise “yine” vurgulanmaya devam etmiştir. PKOS reprodüktif (irregüler menstruel sikluslar, hirsutizm, infertilite, gebelik komplikasyonları, vb), metabolik (insülin rezistansı, metabolik sendrom, diyabet, kardiyovasküler hastalıklar, vb), psikolojik (anksiyete, depresyon, vücut algı bozuklukları, seksüel fonksiyon bozuklukları, yeme bozuklukları vb) özellikleri ile multisistemik bir hastalıktır. Bireysel komponentler üzerinden düşünüldüğü zaman belirgin klinik varyasyon göstermesi tanı ve tedavide farklılıklarla sonuçlanmaktadır. Bu durum ise gecikmiş tanı ve yetersiz bakıma yol açabilmektedir. Bu anlamda 2018 Uluslarası kanıta dayalı PKOS değerlendirme ve yönetim rehberinin eski rehberlerden farklı olarak gündeme getirdiği net tanımlamalar ve pratik öneriler ile olguların değerlendirilmesi ve yönetimindeki standardizasyonun sağlanması için önemli bir adım olduğu düşünülmektedir.

‘Updated’ and ‘reiterated’ views in diagnosis according to recently published guideline for the assessment and management of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is an important public health problem that can have a high prevalence as 10-13%. This syndrome has a heterogeneous nature and may present either with reproductive or metabolic problems in different women. The treatment modalities therefore may differ among patients and also for distinct specialties. However, the ideal approach should consist of standardized diagnostic criteria and the therapeutic applications should consider individual disparities. ‘International evidence-based guideline for the assessment and management of polycystic ovary syndrome’ has been recently published. This guideline includes views of various groups and societies, and defines PCOS more objectively and exhaustively. This consensus guideline states some new perspectives along with reiterating several other facts. PCOS is a multisystem disease consisting of reproductive (irregular menstrual cycles, hirsutism, infertility, pregnancy complications, etc.), metabolic (insulin resistance, metabolic syndrome, diabetes, cardiovascular disorders, etc.), and psychological (anxiety, depression, body dysmorphic disorder, sexual function problems, eating disorders, etc.) aspects. Individual disparities result in different diagnostic and therapeutic approaches. With respect to the heterogeneous nature of the syndrome, this new consensus guideline that brings new and more objective definitions along with practical recommendations, has an important value to further improving evaluation and management standards of the syndrome.

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