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Review
. 2024 Mar;13(1):51-70.
doi: 10.1007/s13679-023-00531-2. Epub 2024 Jan 3.

Hypothalamic-Ovarian axis and Adiposity Relationship in Polycystic Ovary Syndrome: Physiopathology and Therapeutic Options for the Management of Metabolic and Inflammatory Aspects

Maria Serena Lonardo  1 , Nunzia Cacciapuoti  2 , Bruna Guida  2 , Mariana Di Lorenzo  2 , Martina Chiurazzi  2 , Simona Damiano  2 , Ciro Menale  2
Affiliations
Review

Hypothalamic-Ovarian axis and Adiposity Relationship in Polycystic Ovary Syndrome: Physiopathology and Therapeutic Options for the Management of Metabolic and Inflammatory Aspects

Maria Serena Lonardo et al. Curr Obes Rep. 2024 Mar.

Abstract

Purpose of review: The goal of the present review is to address the main adiposity-related alterations in Polycystic Ovary Syndrome (PCOS) focusing on hypothalamic-pituitary-ovarian (H-P-O) axis and to provide an overview of nutraceutical and pharmacological therapeutic strategies.

Recent findings: Female reproduction is a complex and delicate interplay between neuroendocrine signals involving the H-P-O axis. Elements that disrupt the balance of these interactions can lead to metabolic and reproductive disorders, such as PCOS. This disorder includes menstrual, metabolic, and biochemical abnormalities as well as hyperandrogenism, oligo-anovulatory menstrual cycles, insulin resistance, and hyperleptinemia which share an inflammatory state with other chronic diseases. Moreover, as in a self-feeding cycle, high androgen levels in PCOS lead to visceral fat deposition, resulting in insulin resistance and hyperinsulinemia, further stimulating ovarian and adrenal androgen production. In fact, regardless of age and BMI, women with PCOS have more adipose tissue and less lean mass than healthy women. Excessive adiposity, especially visceral adiposity, is capable of affecting female reproduction through direct mechanisms compromising the luteal phase, and indirect mechanisms as metabolic alterations able to affect the function of the H-P-O axis. The intricate crosstalk between adiposity, inflammatory status and H-P-O axis function contributes to the main adiposity-related alterations in PCOS, and alongside currently available hormonal treatments, nutraceutical and pharmacological therapeutic strategies can be exploited to treat these alterations, in order to enable a more comprehensive synergistic and tailored treatment.

Keywords: Adiposity; H-P-O axis; Hyperleptinemia; Low-grade chronic inflammation; PCOS; Tailored therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
PCOS physiopathology and therapeutic options for the management of metabolic and inflammatory aspects. VAT: Visceral Adipose Tissue; SAT: Subcutaneous Adipose Tissue; Red arrows: Adiposity pattern; Orange dotted arrows: Low-grade chronic inflammation pattern; Blue arrows: Hyperandrogenism pattern; Green arrows: Therapeutic options
Fig. 2
Fig. 2
Impaired hypothalamic GnRH secretion and its main physiological and metabolic consequences in PCOS
See this image and copyright information in PMC

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