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


METHODS
Prospective cohort study.


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


METHODS
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.
Endocrinology and Metabolism Unit, Department of Internal Medicine, Hacettepe University School of Medicine, Hacettepe, Ankara, Turkey.
Ayla
A
Harmanci
Nese
N
Cinar
Miyase
M
Bayraktar
Bulent Okan
BO
Yildiz
D000328:Adult; D000736:Androstenes / Q000008:administration & dosage / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000627:therapeutic use*; D005215:Fasting / Q000097:blood; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000378:metabolism; D011085:Polycystic Ovary Syndrome / Q000097:blood* / Q000188:drug therapy* / Q000378:metabolism; D011446:Prospective Studies; D012102:Reproductive Control Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D013148:Spironolactone / Q000008:administration & dosage / Q000627:therapeutic use*; D013739:Testosterone / Q000097:blood; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
D000736:Androstenes; D008076:Cholesterol, HDL; D007328:Insulin; D012102:Reproductive Control Agents; D014280:Triglycerides; C534342:drospirenone and ethinyl estradiol combination; D013148:Spironolactone; D013739:Testosterone; D004997:Ethinyl Estradiol; D002097:C-Reactive Protein