Metabolic and endocrine effects of treatment with peroral or transdermal oestrogens in conjunction with peroral cyproterone acetate in women with polycystic ovary syndrome.
OBJECTIVE
To compare the influence of transdermal and peroral oestrogen treatments in conjunction with cyproterone acetate (CPA) on metabolic and hormonal parameters in women with polycystic ovary syndrome (PCOS).


METHODS
Twenty-four women with PCOS, aged 25.4+/-4.3 (mean+/-s.d.) years, body mass index 24.5+/-3.9 kg/m2 were randomly assigned to receive either transdermal oestradiol plus CPA (n=12) or a peroral oestradiol-CPA combination (n=12). Before and after 3 months of treatment, basal blood samples, euglycaemic hyperinsulinaemic clamp combined with indirect calorimetry and arginine tests were performed. ANOVA and Student's t-test or Wilcoxon's test were used for statistical analyses.


RESULTS
After peroral oestradiol-CPA, insulin sensitivity (P<0.004) and the disposition index as the function of insulin sensitivity and secretion (P<0.0001) decreased significantly. Fasting insulin (P<0.05), cholesterol (P<0.05), high-density lipoprotein cholesterol (P<0.05) and sex-hormone binding globulin (P<0.0001) increased significantly. Dehydroepiandrosterone (P<0.05) and 17-OH progesterone (P<0.01) decreased significantly. After transdermal oestradiol+CPA, no significant changes were observed in sex-hormone binding globulin and androgen concentrations, insulin sensitivity or disposition index.


CONCLUSIONS
In women with PCOS, peroral oestrogens (at doses common in combined oral contraceptives) led to a significant impairment in insulin secretion and action. In contrast, the transdermal application of oestrogens did not significantly influence insulin sensitivity.
Vrbíková
J
J
Institute of Endocrinology, Prague, Czech Republic. jvrbikova@endo.cz
Stanická
S
S
Dvoráková
K
K
Hill
M
M
Vondra
K
K
Bendlová
B
B
Stárka
L
L
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D000704:Analysis of Variance; D001786:Blood Glucose / Q000187:drug effects; D003270:Contraceptive Agents / Q000008:administration & dosage*; D017373:Cyproterone Acetate / Q000008:administration & dosage*; D004338:Drug Combinations; D004958:Estradiol / Q000008:administration & dosage*; D005260:Female; D005934:Glucagon / Q000378:metabolism; D015309:Glucose Clamp Technique; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology; D000078790:Insulin Secretion; D007515:Islets of Langerhans / Q000187:drug effects; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000378:metabolism
D001786:Blood Glucose; D003270:Contraceptive Agents; D004338:Drug Combinations; D007328:Insulin; D017373:Cyproterone Acetate; D004958:Estradiol; D005934:Glucagon