Polycystic ovary syndrome and cardiovascular risk in young patients treated with drospirenone-ethinylestradiol or contraceptive vaginal ring. A prospective, randomized, pilot study.
OBJECTIVE
To compare the effects of a pill containing drospirenone with those of a combined contraceptive vaginal ring on the lipid and carbohydrate metabolism and on the surrogate markers of arterial function.


METHODS
Bologna University School of Medicine.


METHODS
Thirty-seven women with polycystic ovary syndrome (PCOS) were randomly submitted to drospirenone+ethinylestradiol (group I; n=19) or combined contraceptive vaginal ring (group II; n=18) therapy. The duration of the study was 6 months.


METHODS
The effect of treatments was assessed after 6 months of therapy.


METHODS
Utero-ovarian ultrasound analysis and color Doppler evaluation of uterine and stromal ovarian arteries. In addition, analysis of brachial artery flow-mediated vasodilatation and 24-hour ambulatory blood pressure monitoring were performed. Fasting blood samples were drawn for testing biochemical and hormonal parameters and nitrites/nitrates.


RESULTS
Both treatments improved hirsutism, hyperandrogenemia, and ultrasound and color Doppler ovarian parameters. Both drospirenone+ethinylestradiol or contraceptive vaginal ring induced a slight but significant increase of diurnal and 24-hour blood pressure. Although both therapies worsened the lipid profile, the oral pill administration was associated with a more evident increase of circulating triglycerides. The 6-month treatment with the vaginal ring significantly improved the area under the curve for glucose, insulin, and C-peptide, whereas the drospirenone+ethinylestradiol pill induced an increase in the insulinogenic index and homeostatic model assessment estimate for insulin resistance values.


CONCLUSIONS
Vaginal hormonal contraception appears to be preferable to oral ethinylestradiol + drospirenone administration in hyperinsulinemic patients with PCOS.
Battaglia
Cesare
C
Department of Gynecology and Pathophysiology of Human Reproduction, University of Bologna, Bologna, Italy. Electronic address: cesare.battaglia@unibo.it.
Mancini
Fulvia
F
Department of Obstetrics, Gynecology and Reproductive Medicine, Institut Universitari Dexeus, Barcelona, Spain.
Fabbri
Raffaella
R
Department of Gynecology and Pathophysiology of Human Reproduction, University of Bologna, Bologna, Italy.
Persico
Nicola
N
Department of Gynecology and Pathophysiology of Human Reproduction, University of Bologna, Bologna, Italy.
Busacchi
Paolo
P
Department of Gynecology and Pathophysiology of Human Reproduction, University of Bologna, Bologna, Italy.
Facchinetti
Fabio
F
Department of Obstetrics and Gynecology, University of Modena-Reggio Emilia, Modena, Italy.
Venturoli
Stefano
S
Department of Gynecology and Pathophysiology of Human Reproduction, University of Bologna, Bologna, Italy.
D000328:Adult; D000736:Androstenes / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000209:etiology*; D002320:Cardiovascular Physiological Phenomena / Q000187:drug effects; D003267:Contraception / Q000379:methods; D003274:Contraceptive Devices, Female / Q000009:adverse effects; D004997:Ethinyl Estradiol / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D010053:Ovary / Q000098:blood supply / Q000000981:diagnostic imaging; D010865:Pilot Projects; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D012039:Regional Blood Flow / Q000187:drug effects; D012307:Risk Factors; D014463:Ultrasonography; D055815:Young Adult
D000736:Androstenes; D007328:Insulin; C534342:drospirenone and ethinyl estradiol combination; D004997:Ethinyl Estradiol