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

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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.

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