Current aspects of polycystic ovary syndrome II: treatment of hyperandrogenism, insulin resistance and infertility

1. Escobar-Morreale HF. Polycystic ovary syndrome: Definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology. Nature Publishing Group; 2018. p. 270–84.10.1038/nrendo.2018.2429569621Search in Google Scholar

2. Nybacka Å, Hellström PM, Hirschberg AL. Increased fibre and reduced trans fatty acid intake are primary predictors of metabolic improvement in overweight polycystic ovary syndrome—Substudy of randomized trial between diet, exercise and diet plus exercise for weight control. Clinical Endocrinology. Blackwell Publishing Ltd; 2017;87:680–8.10.1111/cen.13427Search in Google Scholar

3. Borsos A, Jakab A. Polycysticus ovarium szindróma. In: Leövey A, Nagy VE, Paragh Gy RK, editors. Az endokrin és anyagcsere-betegségek gyakorlati kézikönyve. Medicina, Budapest; 2011. p. 388–92.Search in Google Scholar

4. Gimes G, Konc J, Lakatos P, Mezősi E, Speer G, Szabolcs I, et al. A PCOS kezelése. In: Lakatos P, Speer G, editors. Policisztás ovarium szindróma. Budapest: Semmelweis Kiadó; 2009. p. 76–104.Search in Google Scholar

5. Kun IZ, Kun I, Kun IZJ. Metabolikus szindróma, diabetes mellitus és a rosszindulatú daganatok. Orvostudományi Értesítő. 2015;88:7–18.Search in Google Scholar

6. Sitruk-Ware R, Nath A. Characteristics and metabolic effects of estrogen and progestins contained in oral contraceptive pills. Best Practice & Research Clinical Endocrinology & Metabolism [Internet]. 2013 [cited 2018 Apr 8];27:13–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2338474210.1016/j.beem.2012.09.00423384742Search in Google Scholar

7. Harmanci A, Cinar N, Bayraktar M, Yildiz BO. Oral contraceptive plus antiandrogen therapy and cardiometabolic risk in polycystic ovary syndrome. Clinical Endocrinology [Internet]. Wiley/Blackwell (10.1111); 2013 [cited 2018 Apr 8];78:120–5. Available from: http://doi.wiley.com/10.1111/j.1365-2265.2012.04466.x10.1111/j.1365-2265.2012.04466.x22702394Search in Google Scholar

8. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism [Internet]. 2013 [cited 2018 Apr 8];98:4565–92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2415129010.1210/jc.2013-2350539949224151290Search in Google Scholar

9. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ (Clinical research ed.) [Internet]. British Medical Journal Publishing Group; 2015 [cited 2018 Apr 9];350:h2135. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2601355710.1136/bmj.h2135444497626013557Search in Google Scholar

10. Bitzer J, Römer T, Lopes da Silva Filho A. The use of cyproterone acetate/ethinyl estradiol in hyperandrogenic skin symptoms – a review. The European Journal of Contraception & Reproductive Health Care [Internet]. 2017 [cited 2018 Apr 9];22:172–82. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2844786410.1080/13625187.2017.131733928447864Search in Google Scholar

11. Kim J-Y, Kim Y-S. Pulmonary embolism and deep vein thrombosis related to oral contraceptive use. Obstetrics & gynecology science [Internet]. Korean Society of Obstetrics and Gynecology; 2013 [cited 2018 Apr 9]; 56:273–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2432801510.5468/ogs.2013.56.4.273378413524328015Search in Google Scholar

12. Parkin L, Sharples K, Hernandez RK, Jick SS. Risk of venous thromboembolism in users of oral contraceptives containing drospirenone or levonorgestrel: Nested case-control study based on UK General Practice Research Database. Bmj. 2011;342.10.1136/bmj.d2139308104121511804Search in Google Scholar

13. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: Guide to the Best Practices in the Evaluation and Treatment of Polycystic Ovary Syndrome - Part 1. Endocrine Practice [Internet]. 2015 [cited 2018 Apr 2];21:1291–300. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2650985510.4158/EP15748.DSC26509855Search in Google Scholar

14. Tabák R, Kemény L. A PCOS szövődményei. Bőrgyógyászati szövődmények. In: Lakatos P, Speer G, editors. Policisztás ovarium szindróma. Budapest: Semmelweis Kiadó; 2009. p. 132–7.Search in Google Scholar

15. Ndefo UA, Eaton A, Green MR. Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P & T : a peer-reviewed journal for formulary management [Internet]. MediMedia, USA; 2013 [cited 2018 Apr 9];38:336–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23946629Search in Google Scholar

16. Okamura Y, Saito F, Takaishi K, Motohara T, Honda R, Ohba T, et al. Polycystic ovary syndrome: early diagnosis and intervention are necessary for fertility preservation in young women with endometrial cancer under 35 years of age. Reproductive Medicine and Biology [Internet]. 2017 [cited 2018 Mar 3];16:67–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2925945310.1002/rmb2.12012571587529259453Search in Google Scholar

17. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Position Statement: Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline. JCEM [Internet]. 2006 [cited 2018 Apr 9];91:4237–45. Available from: http://www.ae-society.org/pdf/guidelines/Criteria.pdf10.1210/jc.2006-017816940456Search in Google Scholar

18. Martin KA, Anderson RR, Chang RJ, Ehrmann DA, Lobo RA, Murad MH, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society* Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism [Internet]. Oxford University Press; 2018 [cited 2018 Apr 9];103:1233–57. Available from: https://academic.oup.com/jcem/article/103/4/1233/492441810.1210/jc.2018-0024129522147Search in Google Scholar

19. Kun IZ, Szántó Z. Neuroendocrinologia. Kolozsvár: Erdélyi Múzeum-Egyesület Kiadó, Kolozsvár, 2012, p.428Search in Google Scholar

20. Gerő L. Metforminkezelés - régi és új szempontok a mindennapi orvosi gyakorlatban. Diabetologia Hungarica. 2012;XX:264–71.Search in Google Scholar

21. Winkler G. Metformin - Újabb adatok egy megbízható és hatékony „régi” vércukorcsökkento készítményrol. Orvosi Hetilap. 2016;157:882–91.10.1556/650.2016.3048527233831Search in Google Scholar

22. Kun IZ, Szántó Z. Mi változott a metabolikus szindróma értelmezésében, diagnózisában és kórtanában az utóbbi huszonöt évben ? Orvostudományi Értesítő. 2013;88:53–68.Search in Google Scholar

23. Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Franks S, Gambineri A, et al. The polycystic ovary syndrome: A position statement from the European Society of Endocrinology. European Journal of Endocrinology. 2014;171:P1–29.10.1530/EJE-14-025324849517Search in Google Scholar

24. Anabtawi A, Miles JM. Metformin: non-glycemic effects and potential novel indications. Endocrine Practice [Internet]. American Association of Clinical Endocrinologists; 2016 [cited 2018 Apr 10];EP151145.RAR. Available from: http://journals.aace.com/doi/10.4158/EP151145.RAR10.4158/EP151145.RARSearch in Google Scholar

25. Yang P-K, Hsu C-Y, Chen M-J, Lai M-Y, Li Z-R, Chen C-H, et al. The Efficacy of 24-Month Metformin for Improving Menses, Hormones, and Metabolic Profiles in Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism [Internet]. Oxford University Press; 2018 [cited 2020 Mar 7];103:890–9. Available from: https://academic.oup.com/jcem/article/103/3/890/479487910.1210/jc.2017-0173929325133Search in Google Scholar

26. Renato P. Metformin in women with PCOS, Pros. Endocrine [Internet]. 2014 [cited 2014 Jun 20]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/24913417Search in Google Scholar

27. Yang P-K, Hsu C-Y, Chen M-J, Lai M-Y, Li Z-R, Chen C-H, et al. The efficacy of 24-month metformin for improving menses, hormone and metabolic profiles in polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism [Internet]. Oxford University Press; 2018 [cited 2018 Apr 8];103:890–9. Available from: http://academic.oup.com/jcem/advance-article/doi/10.1210/jc.2017-01739/479487910.1210/jc.2017-01739Search in Google Scholar

28. Xu W, Deng Y-Y, Yang L, Zhao S, Liu J, Zhao Z, et al. Metformin ameliorates the proinflammatory state in patients with carotid artery atherosclerosis through sirtuin 1 induction. Translational Research [Internet]. Mosby; 2015 [cited 2018 Apr 10];166:451–8. Available from: https://www.sciencedirect.com/science/article/pii/S193152441500207810.1016/j.trsl.2015.06.00226141671Search in Google Scholar

29. Zhou Z, Tang Y, Jin X, Chen C, Lu Y, Liu L, et al. Metformin Inhibits Advanced Glycation End Products-Induced Inflammatory Response in Murine Macrophages Partly through AMPK Activation and RAGE/NFκB Pathway Suppression. Journal of diabetes research [Internet]. Hindawi Limited; 2016 [cited 2018 Apr 10];2016:4847812. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2776147010.1155/2016/4847812505957027761470Search in Google Scholar

30. Penzias A, Bendikson K, Butts S, Coutifaris C, Falcone T, Fossum G, et al. Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline. Fertility and Sterility [Internet]. 2017 [cited 2018 Apr 10];108:426–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2886553910.1016/j.fertnstert.2017.06.02628865539Search in Google Scholar

31. Crowley MJ, Diamantidis CJ, McDuffie JR, Cameron CB, Stanifer JW, Mock CK, et al. Clinical outcomes of metformin use in populations with chronic kidney disease, congestive heart failure, or chronic liver disease: A systematic review. Annals of Internal Medicine. 2017;166:191–200.10.7326/M16-1901529360028055049Search in Google Scholar

32. Hanem LGE, Stridsklev S, Júlíusson PB, Salvesen Ø, Roelants M, Carlsen SM, et al. Metformin Use in PCOS Pregnancies Increases the Risk of Offspring Overweight at 4 Years of Age: Follow-Up of Two RCTs. The Journal of Clinical Endocrinology & Metabolism [Internet]. Oxford University Press; 2018 [cited 2018 Apr 10];103:1612–21. Available from: https://academic.oup.com/jcem/article/103/4/1612/491238610.1210/jc.2017-0241929490031Search in Google Scholar

33. Zhang Z-J, Li S. The prognostic value of metformin for cancer patients with concurrent diabetes: a systematic review and meta-analysis. Diabetes, Obesity and Metabolism [Internet]. 2014 [cited 2018 Apr 8];16:707–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2446089610.1111/dom.1226724460896Search in Google Scholar

34. Shafiee MN, Khan G, Ariffin R, Abu J, Chapman C, Deen S, et al. Preventing endometrial cancer risk in polycystic ovarian syndrome (PCOS) women: Could metformin help? Gynecologic Oncology [Internet]. 2014 [cited 2018 Mar 3];132:248–53. Available from: http://linkinghub.elsevier.com/retrieve/pii/S009082581301277810.1016/j.ygyno.2013.10.02824183733Search in Google Scholar

35. Shao R, Li X, Feng Y, Lin J-F, Billig H. Direct effects of metformin in the endometrium: a hypothetical mechanism for the treatment of women with PCOS and endometrial carcinoma. Journal of experimental & clinical cancer research : CR [Internet]. 2014;33:41. Available from: http://www.pubmed-central.nih.gov/articlerender.fcgi?artid=4036091&tool=pm-centrez&rendertype=abstract10.1186/1756-9966-33-41403609124887156Search in Google Scholar

36. Schuler KM, Rambally BS, Difurio MJ, Sampey BP, Gehrig PA, Makowski L, et al. Antiproliferative and metabolic effects of metformin in a preoperative window clinical trial for endometrial cancer. Cancer Medicine. 2015;4:161–73.10.1002/cam4.353432900125417601Search in Google Scholar

37. Pierotti M, Berrino F, Gariboldi M, Melani C, Mogavero A, Negri T, et al. Targeting metabolism for cancer treatment and prevention: metformin, an old drug with multi-faceted effects. Oncogene [Internet]. Nature Publishing Group; 2012;32:1475–87. Available from: http://dx.doi.org/10.1038/onc.2012.18110.1038/onc.2012.18122665053Search in Google Scholar

38. Brettenthaler N, De Geyter C, Huber PR, Keller U. Effect of the insulin sensitizer pioglitazone on insulin resistance, hyperandrogenism, and ovulatory dysfunction in women with polycystic ovary syndrome. The Journal of clinical endocrinology and metabolism [Internet]. 2004 [cited 2018 Apr 10];89:3835–40. Available from: https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2003-03173710.1210/jc.2003-03173715292314Search in Google Scholar

39. Sepilian V, Nagamani M. Effects of rosiglitazone in obese women with polycystic ovary syndrome and severe insulin resistance. The Journal of clinical endocrinology and metabolism [Internet]. 2005 [cited 2018 Apr 10];90:60–5. Available from: https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2004-137610.1210/jc.2004-137615483106Search in Google Scholar

40. Rautio K, Tapanainen JS, Ruokonen A, Morin-Papunen LC. Endocrine and metabolic effects of rosiglitazone in overweight women with PCOS: a randomized placebo-controlled study. Human reproduction (Oxford, England) [Internet]. 2006 [cited 2018 Apr 10];21:1400–7. Available from: http://academic.oup.com/humrep/article/21/6/1400/724195/Endocrine-and-metabolic-effects-of-rosiglitazone10.1093/humrep/dei50516501039Search in Google Scholar

41. Zhang Y-Y, Hou L-Q, Zhao T-Y. Effects of Acarbose on Polycystic Ovary Syndrome: A Meta-analysis. Experimental and Clinical Endocrinology & Diabetes [Internet]. © Georg Thieme Verlag KG; 2014 [cited 2018 Apr 10];122:373–8. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-137567610.1055/s-0034-137567624941435Search in Google Scholar

42. Lamos EM, Malek R, Davis SN. GLP-1 receptor agonists in the treatment of polycystic ovary syndrome. Expert Review of Clinical Pharmacology [Internet]. 2017 [cited 2018 Apr 10];10:401–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2827677810.1080/17512433.2017.129212528276778Search in Google Scholar

43. Chiu W-Y, Shih S-R, Tseng C-H. A Review on the Association between Glucagon-Like Peptide-1 Receptor Agonists and Thyroid Cancer. Experimental Diabetes Research [Internet]. Hindawi; 2012 [cited 2018 Apr 10];2012:1–7. Available from: http://www.hindawi.com/journals/jdr/2012/924168/10.1155/2012/924168336834022693487Search in Google Scholar

44. Hegedüs L, Moses AC, Zdravkovic M, Le Thi T, Daniels GH. GLP-1 and Calcitonin Concentration in Humans: Lack of Evidence of Calcitonin Release from Sequential Screening in over 5000 Subjects with Type 2 Diabetes or Nondiabetic Obese Subjects Treated with the Human GLP-1 Analog, Liraglutide. The Journal of Clinical Endocrinology & Metabolism [Internet]. Oxford University Press; 2011 [cited 2018 Apr 10];96:853–60. Available from: https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2010-231810.1210/jc.2010-231821209033Search in Google Scholar

45. Balogh S. A D-vitamin-anyagcsere és a policisztás ovárium szindróma. Orvostovábbképző Szemle. 2013;1–6.Search in Google Scholar

46. Seyyed Abootorabi M, Ayremlou P, Behroozi-Lak T, Nourisaeidlou S. The effect of vitamin D supplementation on insulin resistance, visceral fat and adiponectin in vitamin D deficient women with polycystic ovary syndrome: a randomized placebo-controlled trial. Gynecological Endocrinology [Internet]. 2017 [cited 2018 Apr 10];1–6. Available from: https://www.tandfonline.com/doi/full/10.1080/09513590.2017.141831110.1080/09513590.2017.141831129271278Search in Google Scholar

47. Irani M, Merhi Z. Role of vitamin D in ovarian physiology and its implication in reproduction: a systematic review. Fertility and Sterility [Internet]. 2014 [cited 2018 Apr 10];102:460-468.e3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2493312010.1016/j.fertnstert.2014.04.04624933120Search in Google Scholar

48. Gupta T, Rawat M, Gupta N, Arora S. Study of Effect of Vitamin D Supplementation on the Clinical, Hormonal and Metabolic Profile of the PCOS Women. The Journal of Obstetrics and Gynecology of India [Internet]. 2017 [cited 2018 Apr 10];67:349–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2886788610.1007/s13224-017-1008-1556175228867886Search in Google Scholar

49. Akbari M, Ostadmohammadi V, Lankarani K, Tabrizi R, Kolahdooz F, Heydari S, et al. The Effects of Vitamin D Supplementation on Biomarkers of Inflammation and Oxidative Stress Among Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Hormone and Metabolic Research [Internet]. 2018 [cited 2018 Apr 10];50:271–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2947521210.1055/s-0044-10135529475212Search in Google Scholar

50. Trummer C, Schwetz V, Kollmann M, Wölfler M, Münzker J, Pieber TR, et al. Effects of vitamin D supplementation on metabolic and endocrine parameters in PCOS: a randomized-controlled trial. European Journal of Nutrition [Internet]. Springer Berlin Heidelberg; 2019;58:2019–28. Available from: http://dx.doi.org/10.1007/s00394-018-1760-810.1007/s00394-018-1760-8664722429946756Search in Google Scholar

51. Genazzani AD. Inositol as putative integrative treatment for PCOS. Reproductive BioMedicine Online [Internet]. Elsevier Ltd; 2016;33:770–80. Available from: http://dx.doi.org/10.1016/j.rbmo.2016.08.02410.1016/j.rbmo.2016.08.02427717596Search in Google Scholar

52. Papaleo E, Unfer V, Baillargeon JP, Chiu TT. Contribution of myo-inositol to reproduction. European Journal of Obstetrics Gynecology and Reproductive Biology. 2009;147:120–3.10.1016/j.ejogrb.2009.09.00819800728Search in Google Scholar

53. Banaszewska B, Wrotyńska-Barczyńska J, Spaczynski RZ, Pawelczyk L, Duleba AJ. Effects of resveratrol on polycystic ovary syndrome: A double-blind, randomized, placebo-controlled trial. Journal of Clinical Endocrinology and Metabolism. 2016;101:4322–8.10.1210/jc.2016-185827754722Search in Google Scholar

54. Pasquali R, Gambineri A. Insulin-sensitizing agents in polycystic ovary syndrome. European Journal of Endocrinology [Internet]. [cited 2018 Apr 10];154:763–75. Available from: http://www.eje-online.org/content/154/6/763.full.pdf10.1530/eje.1.0215616728533Search in Google Scholar

55. Saydam B, Yildiz B. Gut-Brain Axis and Metabolism in Polycystic Ovary Syndrome. Current Pharmaceutical Design [Internet]. 2016 [cited 2018 Apr 9];22:5572–87. Available from: http://www.eurekaselect.com/openurl/content.php?genre=article&issn=1381-6128&volume=22&issue=36&spage=557210.2174/138161282266616071514393327426125Search in Google Scholar

56. Torres PJ, Siakowska M, Banaszewska B, Pawelczyk L, Duleba AJ, Kelley ST, et al. Gut Microbial Diversity in Women With Polycystic Ovary Syndrome Correlates With Hyperandrogenism. The Journal of Clinical Endocrinology & Metabolism [Internet]. 2018 [cited 2018 Apr 8];103:1502–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2937041010.1210/jc.2017-02153627658029370410Search in Google Scholar

57. Liu R, Zhang C, Shi Y, Zhang F, Li L, Wang X, et al. Dysbiosis of Gut Microbiota Associated with Clinical Parameters in Polycystic Ovary Syndrome. Frontiers in microbiology [Internet]. Frontiers Media SA; 2017 [cited 2018 Apr 9];8:324. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2829323410.3389/fmicb.2017.00324532895728293234Search in Google Scholar

58. Malik SM, Traub ML. Defining the role of bariatric surgery in polycystic ovarian syndrome patients. World Journal of Diabetes [Internet]. 2012;3:71–9. Available from: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=-pubmed&id=22532886&retmode=ref&cmd=prlinks%5Cn-papers3://publication/doi/10.4239/wjd.v3.i4.7110.4239/wjd.v3.i4.71333438922532886Search in Google Scholar

59. Corcelles R, Daigle CR, Schauer PR. Metabolic effects of bariatric surgery. European Journal of Endocrinology. 2016;174:R19–28.10.1530/EJE-15-053326340972Search in Google Scholar

60. Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: An analysis of the evidence to support the development of global WHO guidance. Human Reproduction Update. 2016;22:687–708.10.1093/humupd/dmw02527511809Search in Google Scholar

61. Palomba S, Falbo a, La Sala GB. Effects of metformin in women with polycystic ovary syndrome treated with gonadotrophins for in vitro fertilisation and intracytoplasmic sperm injection cycles: a systematic review and meta-analysis of randomised controlled trials. BJOG : an international journal of obstetrics and gynaecology [Internet]. 2013 [cited 2014 Jun 20];120:267–76. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2319419910.1111/1471-0528.1207023194199Search in Google Scholar

62. Parsanezhad ME, Alborzi S, Jahromi BN. A prospective, double-blind, randomized, placebo-controlled clinical trial of bromocriptine in clomiphene-resistant patients with polycystic ovary syndrome and normal prolactin level. International journal of fertility and women’s medicine [Internet]. [cited 2020 Mar 8];47:272–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12570169Search in Google Scholar

63. Effect of Bromocriptine on Insulin Resistance in Polycystic Ovarian Syndrome - A Pilot Study - No Study Results Posted - ClinicalTrials.gov [Internet]. [cited 2020 Mar 8]. Available from: https://clinicaltrials.gov/ct2/show/results/NCT02133755Search in Google Scholar