Oral contraceptive plus antiandrogen therapy and cardiometabolic risk in polycystic ovary syndrome.

Abstract

OBJECTIVE:

Oral contraceptives alone or in combination with antiandrogens are commonly used in the treatment for polycystic ovary syndrome (PCOS). We aimed to determine the effects of ethinyl estradiol/drospirenone (EE-DRSP) plus spironolactone therapy on inflammation and cardiometabolic risk in PCOS.

DESIGN:

Prospective cohort study.

PATIENTS:

Twenty-three lean, normal glucose-tolerant patients with PCOS and 23 age- and body mass index (BMI)-matched healthy control women.

MEASUREMENTS:

Androgens, high-sensitivity C-reactive protein (hsCRP), homocysteine, lipids, fasting insulin, and glucose levels during a standard 75-g, 2-h oral glucose tolerance test were measured. Patients with PCOS were evaluated before and after receiving EE-DRSP (3 mg/30 μg) plus spironolactone (100 mg/day) for 6 months. Healthy controls were evaluated at baseline only.

RESULTS:

hsCRP, homocysteine, lipids, insulin and glucose levels were similar between patient and control groups at baseline. EE-DRSP plus spironolactone increased hsCRP and homocysteine levels in patients with PCOS (0.50 ± 0.28 vs 1.5 ± 1.3 mg/l, P < 0.05 and 13.1 ± 5.2 vs 17.6 ± 5.3 μm, P < 0.05, respectively). BMI, waist-to-hip ratio, LDL, HDL cholesterol and triglycerides, and glucose tolerance did not change. Modified Ferriman-Gallwey hirsutism scores, testosterone levels and free androgen index improved (9.1 ± 4.2 vs 6.2 ± 3.4, P = 0.001; 80.6 ± 31.1 47.8 ± 20.3 ng/dl, P < 0.05; and 10.5 ± 7.4 vs 1.1 ± 0.8, P < 0.001, respectively).

CONCLUSIONS:

EE-DRSP plus spironolactone therapy in 6 months improves androgen excess in lean PCOS women without any adverse effects on adiposity, glucose tolerance status or lipid profile. However, this combination increases hsCRP and homocysteine levels.

• Authors: Ayla Harmanci, Nese Cinar, Miyase Bayraktar, Bulent Okan Yildiz
• Journal: Clinical endocrinology (Clin Endocrinol (Oxf)) Vol. 78 Issue 1 Pg. 120-5 (Jan 2013) ISSN: 1365-2265 [Electronic] England
• PMID: 22702394 (Publication Type: Journal Article)
• Copyright: © 2012 Blackwell Publishing Ltd.

Chemical References

• Androstenes
• Cholesterol, HDL
• Insulin
• Reproductive Control Agents
• Triglycerides
• drospirenone and ethinyl estradiol combination
• Spironolactone
• Testosterone
• Ethinyl Estradiol
• C-Reactive Protein

Topics

• Adult
• Androstenes (administration & dosage, therapeutic use)
• C-Reactive Protein (metabolism)
• Cholesterol, HDL (blood)
• Ethinyl Estradiol (administration & dosage, therapeutic use)
• Fasting (blood)
• Female
• Glucose Tolerance Test
• Humans
• Insulin (metabolism)
• Polycystic Ovary Syndrome (blood, drug therapy, metabolism)
• Prospective Studies
• Reproductive Control Agents (administration & dosage, therapeutic use)
• Spironolactone (administration & dosage, therapeutic use)
• Testosterone (blood)
• Triglycerides (blood)
• Young Adult