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Endometrium in PCOS: Implantation and predisposition to endocrine CA.

Abstract

Polycystic ovarian syndrome (PCOS) is a common endocrinopathy characterized by oligo/anovulatiaon and elevated circulating androgens or evidence of hyperandrogenism after all known potential causes have been excluded. In addition, insulin resistance and accompanying hyperinsulinemia commonly occur in women with PCOS. There is increasing evidence that the endocrinologic and metabolic abnormalities in PCOS may have complex effects on the endometrium, contributing to the infertility and endometrial disorders observed in women with this syndrome. Androgen receptors and steroid receptor co-activators are over-expressed in the endometrium of women with PCOS. Also, biomarkers of endometrial receptivity to embryonic implantation-such as alpha(v)beta3-integrin and glycodelin-are decreased, and epithelial expression of estrogen receptor alpha (ERalpha) abnormally persists in the window of implantation in endometrium in women with PCOS. In addition to being responsive to the steroid hormones estradiol, progesterone, and androgens, the endometrium is also a target for insulin, the receptor for which is cyclically regulated in normo-ovulatory women. In vitro, insulin inhibits the normal process of endometrial stromal differentiation (decidualization). In addition, insulin-like growth factors (IGFs) and their binding proteins are regulated in and act on endometrial cellular constituents, and hyperinsulinemia down-regulates hepatic IGFBP-1, resulting in elevated free IGF-I in the circulation. Thus, elevated estrogen (without the opposing effects of progesterone in the absence of ovulation), hyperinsulinemia, elevated free IGF-I and androgens, and obesity all likely contribute to endometrial dysfunction, infertility, increased miscarriage rate, endometrial hyperplasia, and endometrial cancer common in women with PCOS. The potential mechanisms underlying these disorders, specifically in women with PCOS, are complex and await additional transdisciplinary research for their complete elucidation.

Authors+Show Affiliations

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 505 Parnassus Avenue, M1496, Box 0132, San Francisco, CA 94143-0132, USA. giudice@obgyn.ucsf.edu

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Review

Language

eng

PubMed ID

16772154

Citation

Giudice, Linda C.. "Endometrium in PCOS: Implantation and Predisposition to Endocrine CA." Best Practice & Research. Clinical Endocrinology & Metabolism, vol. 20, no. 2, 2006, pp. 235-44.
Giudice LC. Endometrium in PCOS: Implantation and predisposition to endocrine CA. Best Pract Res Clin Endocrinol Metab. 2006;20(2):235-44.
Giudice, L. C. (2006). Endometrium in PCOS: Implantation and predisposition to endocrine CA. Best Practice & Research. Clinical Endocrinology & Metabolism, 20(2), pp. 235-44.
Giudice LC. Endometrium in PCOS: Implantation and Predisposition to Endocrine CA. Best Pract Res Clin Endocrinol Metab. 2006;20(2):235-44. PubMed PMID: 16772154.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endometrium in PCOS: Implantation and predisposition to endocrine CA. A1 - Giudice,Linda C, PY - 2006/6/15/pubmed PY - 2006/8/12/medline PY - 2006/6/15/entrez SP - 235 EP - 44 JF - Best practice & research. Clinical endocrinology & metabolism JO - Best Pract. Res. Clin. Endocrinol. Metab. VL - 20 IS - 2 N2 - Polycystic ovarian syndrome (PCOS) is a common endocrinopathy characterized by oligo/anovulatiaon and elevated circulating androgens or evidence of hyperandrogenism after all known potential causes have been excluded. In addition, insulin resistance and accompanying hyperinsulinemia commonly occur in women with PCOS. There is increasing evidence that the endocrinologic and metabolic abnormalities in PCOS may have complex effects on the endometrium, contributing to the infertility and endometrial disorders observed in women with this syndrome. Androgen receptors and steroid receptor co-activators are over-expressed in the endometrium of women with PCOS. Also, biomarkers of endometrial receptivity to embryonic implantation-such as alpha(v)beta3-integrin and glycodelin-are decreased, and epithelial expression of estrogen receptor alpha (ERalpha) abnormally persists in the window of implantation in endometrium in women with PCOS. In addition to being responsive to the steroid hormones estradiol, progesterone, and androgens, the endometrium is also a target for insulin, the receptor for which is cyclically regulated in normo-ovulatory women. In vitro, insulin inhibits the normal process of endometrial stromal differentiation (decidualization). In addition, insulin-like growth factors (IGFs) and their binding proteins are regulated in and act on endometrial cellular constituents, and hyperinsulinemia down-regulates hepatic IGFBP-1, resulting in elevated free IGF-I in the circulation. Thus, elevated estrogen (without the opposing effects of progesterone in the absence of ovulation), hyperinsulinemia, elevated free IGF-I and androgens, and obesity all likely contribute to endometrial dysfunction, infertility, increased miscarriage rate, endometrial hyperplasia, and endometrial cancer common in women with PCOS. The potential mechanisms underlying these disorders, specifically in women with PCOS, are complex and await additional transdisciplinary research for their complete elucidation. SN - 1521-690X UR - https://www.unboundmedicine.com/medline/citation/16772154/Endometrium_in_PCOS:_Implantation_and_predisposition_to_endocrine_CA_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1521-690X(06)00027-3 DB - PRIME DP - Unbound Medicine ER -