title: Combined use of metformin and ethinyl estradiol-cyproterone acetate in polycystic ovary syndrome.
abstract: OBJECTIVE
  The aim of our study was to compare the effect of metformin applied independently to the effect of metformin used in combination with oral contraceptive containing ethinyl estradiol (EE) and cyproterone acetate (CA).
  
  
  METHODS
  This prospective, open clinical study lasted 6 months and included 30 women with PCOS, divided in two groups of 15 women each. Group 1 received 850 mg metformin twice a day and group 2 in which Diane35 was added to the same treatment only during the first 2 months of the investigation. Serum levels of testosterone, immune reactive insulin (IRI), sex hormone binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS) and lipid metabolism parameters were measured before the treatment, on the third and sixth month. Free androgen index (FAI) and HOMA-IR were calculated. Body mass index (BMI) and waist-to-hip ratio (WHR) were assessed at baseline and at the end of therapy.
  
  
  RESULTS
  Much better and faster decrease in the level of testosterone and free androgen index in group with combined use of metformin and Diane35 was established, without deterioration of the anthropometric and biochemical indices and insulin sensitivity.
  
  
  CONCLUSIONS
  The combination of metformin with intermittent application of Diane35 is an appropriate alternative for the pathogenic influence and clinical improvement of the symptoms of androgen excess in cases with PCOS.
authors.affiliation: Department of Endocrinology, Medical University, Plovdiv, Bulgaria.
authors.forename: M
authors.initials: M
authors.lastname: Mitkov
authors.forename: B
authors.initials: B
authors.lastname: Pehlivanov
authors.forename: D
authors.initials: D
authors.lastname: Terzieva
mesh_terms: D000328:Adult; D000726:Androgen Antagonists / Q000008:administration & dosage*; D015992:Body Mass Index; D017373:Cyproterone Acetate / Q000008:administration & dosage*; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004997:Ethinyl Estradiol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008687:Metformin / Q000008:administration & dosage*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy*; D011446:Prospective Studies; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D013739:Testosterone / Q000097:blood; D049629:Waist-Hip Ratio
chemical_list: D000726:Androgen Antagonists; D004338:Drug Combinations; D007004:Hypoglycemic Agents; D007328:Insulin; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D004997:Ethinyl Estradiol; D017373:Cyproterone Acetate; D019314:Dehydroepiandrosterone Sulfate; C032640:Cyproterone acetate, ethinyl estradiol drug combination; D008687:Metformin