The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. The effect of ethinyl estradiol–cyproterone acetate treatment on homocysteine levels in women with polycystic ovary syndrome Metformin or antiandrogen in the treatment of hirsutism in polycystic ovary syndrome. The effect of combination therapy with metformin and combined oral contraceptives (COC) versus COC alone on insulin sensitivity, hyperandrogenaemia, SHBG and lipids in PCOS patients. Androgen and lipid profiles in adolescents with polycystic ovary syndrome who were treated with two forms of combined oral contraceptives. Simvastatin improves biochemical parameters in women with polycystic ovary syndrome: results of a prospective, randomized trial. The administration of estrogens, combined with anti-androgens, has beneficial effects on the hormonal features and asymmetric dimethyl-arginine levels, in women with the polycystic ovary syndrome. Endothelial function and insulin resistance in polycystic ovary syndrome: the effects of medical therapy. The effects of oral contraceptives including low-dose estrogen and drospirenone on the concentration of leptin and ghrelin in polycystic ovary syndrome. Weight change and androgen levels during contraceptive treatment of women affected by polycystic ovary. Efficacy of an oral contraceptive containing drospirenone in the treatment of women with polycystic ovary syndrome Ethinylestradiol/cyproterone acetate in polycystic ovary syndrome: lipid and carbohydrate changes Comparison of four different treatment regimes in hirsutism related to polycystic ovary syndrome. Combined oral contraceptive treatment of adolescent girls with polycystic ovary syndrome. Lipid profile. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. Randomized Controlled Trial Evaluating Response to Metformin Versus Standard Therapy in the Treatment of Adolescents with Polycystic Ovary Syndrome Increased follistatin levels after oral contraceptive treatment in obese and non-obese women with polycystic ovary syndrome. [Ultrasonographic and lipid changes in polycystic ovary syndrome according to the type of treatment ].
CONTEXT Polycystic ovary syndrome ( PCOS ) presents in adolescence , and obesity is a common finding . The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear . OBJECTIVE We investigated the effects of metformin , oral contraceptives ( OCs ) , and /or lifestyle modification in obese adolescent women with PCOS . DESIGN Two small , r and omized , placebo-controlled clinical trials were performed . PATIENTS AND PARTICIPANTS A total of 79 obese adolescent women with PCOS participated . INTERVENTIONS In the single treatment trial , subjects were r and omized to metformin , placebo , a lifestyle modification program , or OC . In the combined treatment trial , all subjects received lifestyle modification and OC and were r and omized to metformin or placebo . MAIN OUTCOME MEASURES Serum concentrations of and rogens and lipids were measured . RESULTS Lifestyle modification alone result ed in a 59 % reduction in free and rogen index with a 122 % increase in SHBG . OC result ed in a significant decrease in total testosterone ( 44 % ) and free and rogen index ( 86 % ) but also result ed in an increase in C-reactive protein ( 39.7 % ) and cholesterol ( 14 % ) . The combination of lifestyle modification , OC , and metformin result ed in a 55 % decrease in total testosterone , as compared to 33 % with combined treatment and placebo , a 4 % reduction in waist circumference , and a significant increase in HDL ( 46 % ) . CONCLUSIONS In these preliminary trials , both lifestyle modification and OCs significantly reduce and rogens and increase SHBG in obese adolescents with PCOS . Metformin , in combination with lifestyle modification and OC , reduces central adiposity , reduces total testosterone , and increases HDL , but does not enhance overall weight reduction Objective Women with polycystic ovary syndrome ( PCOS ) have multiple risk factors for cardiovascular disease . The cardiovascular risk marker homocysteine ( Hcy ) is elevated in women with PCOS . This prospect i ve study investigated the effect of oral contraceptives containing ethinyl estradiol – cyproterone acetate ( EE – CA ) on serum Hcy levels in women with PCOS . Study design A total of 30 women with PCOS were enrolled in this prospect i ve study . The diagnosis of PCOS was made according to the criteria of the Rotterdam PCOS consensus workshop group . All women  took oral contraceptives containing EE/CA ( 35 μg/2 mg ) for 3 months . Serum sample s for Hcy , lipid profile and hormones were obtained during the early follicular phase ( days 3–5 ) of the spontaneous or progestin-induced bleeding at baseline , and after the third treatment cycle . Results Three months of EE – CA therapy significantly decreased the Hcy levels from 55.97 ± 16.04 to 54.03 ± 16.15 ( P = 0.01 ) . A significant correlation was observed between the Hcy and total and free testosterone levels ( r = 0.44 , P = 0.015 and r = 0.46 , P = 0.001 respectively ) . Conclusions Although the decrease in Hcy levels with EE – CA therapy was statistically significant , further studies are necessary to determine the clinical benefit of this treatment Hirsutism is a common and distressing symptom frequently encountered in women with polycystic ovary syndrome ( PCOS ) , who also show relative insulin resistance . The aim of this trial , in which hirsutism was the primary end point , was to compare the efficacy of the oral antihyperglycemic medication metformin with that of an established treatment , combined ethinyl estradiol and cyproterone acetate .  Patients ( n = 52 ) were r and omized to receive either metformin ( 500 mg , three times daily ) or Dianette ( ethinyl estradiol , 35 micro g ; cyproterone acetate , 2 mg ) treatment for 12 months , with assessment s before treatment , at 6 months , and at 12 months . Both objective and subjective methods of evaluating hirsutism were used , and in addition , patient perceptions were examined . The results show that metformin is potentially an effective treatment for moderate to severe hirsutism in women with PCOS . They also suggest that in some respects ( Ferriman-Gallwey score and patient self- assessment ) , it is more efficacious than the st and ard treatment ( Dianette ) . The objective evaluation of hair diameter reduction showed that both treatments were moderately effective at multiple anatomical sites . Dianette treatment was responsible for profound suppression of and rogen activity , in contrast to metformin , which induced negligible change . However , metformin did reduce markers of insulin resistance . The data suggest that hirsutism may be effectively treated by reducing hyperinsulinemia BACKGROUND Neither oral contraceptives ( COC ) nor metformin are an optimal modality for the long-term treatment of polycystic ovary syndrome ( PCOS ) . The aim of this study was to evaluate whether a combination of both is beneficial over COC monotherapy . METHODS Altogether , 30 women were included in the study and 28 finished the protocol . The patients were r and omly assigned to two groups treated with either COC ( COC group ) or COC and metformin ( 1500 mg/day ) ( METOC group ) for 6 months . Anthropometric parameters , and rogens , lipids , fasting insulin , glucose and sex hormone binding globulin ( SHBG ) concentrations were measured before and at the end of the sixth cycle of treatment . The insulin sensitivity index was evaluated using the euglycaemic clamp . RESULTS There were no significant changes in anthropometric parameters , fasting glucose or insulin sensitivity in either group . Total testosterone , free and rogen index , and rostenedione and dehydroepi and rosterone decreased and SHBG increased significantly in both groups . When comparing the effect of both treatments , only a more pronounced decrease in free and rogen index was found in the METOC group . CONCLUSIONS Adding metformin slightly modified the treatment effect of COC , causing a more significant decrease in the free and rogen index but having no additional positive impact on lipids , insulin sensitivity , SHBG or testosterone . The available data do not offer enough evidence to advocate the st and ard use of combined treatment in PCOS . Whether the combination might be beneficial for specific subgroups of patients is of further interest OBJECTIVE To compare the effects of cyproterone acetate and desogestrel , as part of combined oral contraceptives , on lipid metabolism and  hirsutism of adolescents with polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve r and omized clinical trial . SETTING Outpatient gynecology clinic ( referral center ) of a university . PATIENT(S ) Twenty-eight adolescent girls with clinical and biological hyper and rogenism and six or less menses during the past 12 months . INTERVENTION(S ) Group A ( n = 14 ) received 0.15 mg of desogestrel plus 0.030 mg of ethinyl estradiol daily . Group B ( n = 14 ) received 2 mg of cyproterone acetate plus 0.035 mg of ethinyl estradiol daily . Treatment was given for 21 days followed by a 7-day rest for a period of 12 months . MAIN OUTCOME MEASURE(S ) Hirsutism and lipid profile were evaluated before initiation and at 3 , 6 , 9 , and 12 months of treatment . And rogen profile was evaluated before and at 12 months of treatment . RESULT ( S ) A significant decline of the Ferriman-Gallway hirsutism score was observed from the sixth month of therapy in both groups . During therapy , the levels of testosterone , free testosterone , Delta(4)- and rostenedione , and 17OH-progesterone decreased significantly , whereas sex hormone-binding globulin ( SHBG ) increased significantly in both groups . The level of total cholesterol and low density lipoprotein ( LDL ) cholesterol increased significantly , whereas high density lipoprotein ( HDL ) cholesterol and apolipoprotein A-I increased significantly from the third month of therapy in both groups . Total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios remained unchanged . The levels of triglycerides increased significantly in the cyproterone acetate-treated group after the third month . CONCLUSION ( S ) Treatment of adolescent girls with PCOS with the two studied formulations is comparably effective in decreasing hirsutism and and rogen levels . Both combined oral contraceptives are associated with an increase of total cholesterol , LDL cholesterol , and HDL cholesterol levels and no change of the total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios . Treatment with the cyproterone acetate combined oral contraceptive is associated with a tendency toward increasing the levels of triglycerides OBJECTIVE To test the hypothesis that statins improve hyper and rogenemia in women with polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve , r and omized trial . SETTING Academic medical center . PATIENT(S ) Forty-eight women with PCOS . INTERVENTION(S ) Subjects were r and omized to a statin group ( simvastatin , 20 mg daily plus oral contraceptive pill [ OCP ] ; n = 24 ) or an OCP group ( OCP alone ; n = 24 ) . MAIN OUTCOME MEASURE(S ) Serum T. RESULT ( S ) Baseline parameters of both groups were comparable . After 12 weeks of treatment , serum T levels declined by 41 % in the statin group and by 14 % in the OCP group . In the statin group , there was a greater decrease of LH ( 43 % decrease vs. 9 % in the OCP group ) and a greater decline of LH/FSH ratio ( 44 % vs. 12 % ) . In the statin group , total cholesterol declined by 10 % and low-density lipoprotein ( LDL ) by 24 % . In the OCP group , total cholesterol increased by 8 % , and LDL was unchanged . CONCLUSION ( S ) This is the first study demonstrating that statin decreases T levels and normalizes gonadotropin levels in women with PCOS . Statin therapy might offer a novel approach , providing endocrine and cardiovascular benefits The present study was design ed in order to : ( a ) compare ET-1 and ADMA levels , between women with PCOS ( n=106 ) and healthy controls ( n=30 ) ; ( b ) determine the effects of treatment with estrogens and anti- and rogens on the hormonal features of PCOS , insulin resistance , ET-1 and ADMA levels . Women with PCOS were r and omized in five therapeutic protocol s : ( I ) 17beta-estradiol+cyproterone acetate 50 mg ; ( II ) conjugated estrogen+CA 50 mg ; ( III ) ethinyl estradiole+CA 2 mg ; ( IV ) EE+CA 52 mg ; ( V ) EE+desogestrel . In all women , gonadotropin , PRL , and rogen , SHBG , insulin , glucose , ET-1 and ADMA levels were determined ; in women with PCOS , testosterone , SHBG , ET-1 and ADMA levels were measured again after 3 , 6 , 12 months of treatment and insulin and glucose levels after 12 months . ET-1 and ADMA concentrations were higher in women with PCOS , and they were positively correlated with each other . ADMA levels were decreased and IR was increased with treatment . Treatment with synthetic estrogens ( EE ) result ed in a more pronounced increase in SHBG and a more pronounced decrease in FAI , compared to natural estrogens . Conclusively , PCOS is associated with endothelial dysfunction , which is ameliorated by the administration of estrogens and anti- and rogens , independent of IR OBJECTIVE To assess the interaction between insulin resistance and endothelial function and the optimal treatment strategy addressing cardiovascular risk in polycystic ovary syndrome . DESIGN R and omized controlled trial . SETTING Controlled clinical study . PATIENT(S ) Overweight age- and body mass index-matched women with polycystic ovary syndrome . INTERVENTION(S ) Six months metformin ( 1 g two times per day , n = 36 ) or oral contraceptive pill ( OCP ) ( 35 microg ethinyl E(2)-2 mg cytoproterone acetate , n = 30 ) . MAIN OUTCOME MEASURE(S ) Fasting and oral glucose tolerance test glucose and insulin levels , endothelial function ( flow-mediated dilation , asymmetric dimethylarginine , plasminogen activator inhibitor-1 , von Willebr and factor ) , inflammatory markers ( high-sensitivity C-reactive protein ) , lipids , and hyper and rogenism . RESULT ( S ) The OCP increased levels of glucose and insulin on oral glucose tolerance test , high-sensitivity C-reactive protein , triglycerides , and sex-hormone binding globulin and decreased levels of low-density lipoprotein cholesterol and T.  Metformin decreased levels of fasting insulin , oral glucose tolerance test insulin , high-density lipoprotein cholesterol , and high-sensitivity C-reactive protein . Flow-mediated dilation increased only with metformin ( + 2.2 % + /- 4.8 % ) , whereas asymmetric dimethylarginine decreased equivalently for OCP and metformin ( -0.3 + /- 0.1 vs. -0.1 + /- 0.1 mmol/L ) . Greater decreases in plasminogen activator inhibitor-1 occurred for the OCP than for metformin ( -1.8 + /- 1.6 vs. -0.7 + /- 1.7 U/mL ) . CONCLUSION ( S ) In polycystic ovary syndrome , metformin improves insulin resistance , inflammatory markers , and endothelial function . The OCP worsens insulin resistance and glucose homeostasis , inflammatory markers , and triglycerides and has neutral or positive endothelial effects . The effect of the OCP on cardiovascular risk in polycystic ovary syndrome is unclear OBJECTIVE To evaluate short-term leptin and ghrelin concentrations in women with polycystic ovary syndrome ( PCOS ) who use low-dose oral contraceptives containing drospirenone .  DESIGN Prospect i ve study . SETTING Department of obstetrics and gynaecology in a university hospital . PATIENT(S ) Twenty women with PCOS were enrolled in the study . INTERVENTION(S ) A low-dose oral contraceptive containing ethinyl estradiol and drospirenone was given for three cycles . MAIN OUTCOME MEASURE(S ) Serum and rostenedione , free T , T , dehydroepi and rosterone sulphate , sex hormone-binding globulin , FSH , LH , E(2 ) , lipid profiles , leptin , and ghrelin levels were measured in each subject . Insulin resistance was estimated by the homeostasis model assessment -insulin resistance ( HOMA-IR ) . RESULT ( S ) While leptin concentrations did not change with therapy , ghrelin levels increased statistically . Baseline leptin concentrations were correlated positively with body mass index , waist-to-hip ratio , insulin , and HOMA-IR and negatively with ghrelin . After controlling for body mass index and waist-to-hip ratio in a partial correlation analysis , leptin levels were not correlated with these parameters . Ghrelin was inversely correlated with body mass index , waist-to-hip ratio , insulin , HOMA-IR , and free T. CONCLUSION ( S ) In patients with PCOS , an oral contraceptive containing ethinyl estradiol and drospirenone increases ghrelin levels but not leptin levels in a 3-month period . Ghrelin might be related to the metabolic and and rogenic changes in patients with PCOS OBJECTIVE The aim of this study was to investigate the effect of oral contraceptive Diane 35 ( ethinylestradiol + cyproteroneacetate EE/CPA ) which is widely used in the treatment of PCOS in Europe , on body weight , lipid levels and endocrine parameters in non-obese women with PCOS . SUBJECTS AND METHODS Nineteen PCOS women were examined in the early follicular phase of menstrual cycle , blood sample s for the estimation of cholesterol ( C ) , HDL cholesterol ( HDL-C ) , triglycerides ( TG ) , testosterone ( T ) , and rostenedione ( A ) , dehydroepi and rosterone sulfate ( DHEAS ) and sex hormone binding globulin ( SHBG ) were taken before the start of treatment with Diane 35 and again after 7 + /- 3.8 months of treatment with Diane 35 .  Body weight ( W ) was recorded at the time of both examinations . RESULTS After the treatment with Diane 35 the levels of W ( p<0.05 ) , total C ( p<0.05 ) , TG ( p<0.004 ) and SHBG ( p<0.0001 ) increased significantly . In addition , significant negative correlation between SHBG levels before treatment and increase of W after Diane 35 was found ( r= -0.56 ; p<0.02 ) . Increase of W correlated negatively with T before treatment ( r= 0.58 ; p < .02 ) and positively with the change in T level after treatment ( r=0.50 ; p<0.05 ) . CONCLUSIONS Increase of body weight in a significant number of PCOS-affected women was seen after treatment with Diane 35 and it is assumed to blunt ameliorating effects of this treatment on and rogen levels . Considering our findings , we conclude that the treatment with CPA/EE can result in significant weight gain ameliorating positive effects of the treatment on and rogen levels . These findings could underline the necessity of the finding new therapeutical options for PCOS , besides contraception . Studies concerning body composition during contraceptive treatment in PCOS would be also useful in the future Objective To investigate the efficacy of a combined oral contraceptive containing 30 µg ethinyloestradiol and 3 mg drospirenone in the treatment of hyper and rogenism affecting women with the polycystic ovary syndrome ( PCOS ) . Methods Prospect i ve open study of 20 women for six cycles . At the beginning and at the end of the study the following values were determined : the Ferriman – Gallwey ( F – G ) score , body mass index , waist/hip ratio , serum levels of testosterone , SHBG , immune reactive insulin ( IRI ) , glucose , the free and rogenic index , and insulin resistance ( HOMA-IR ) . Results All 20 women completed six cycles of therapy . The medication was well tolerated . At the end of the study there was a significant improvement of hirsutism , expressed in the decrease of the F – G score , accompanied by a decrease of testosterone and an increase of SHBG values . The carbohydrate metabolism was not affected significantly . Conclusion The combined oral contraceptive containing 30 µg ethinyloestradiol and 3 mg drospirenone is an effective drug in the treatment of hyper and rogenism in women with PCOS ; it elicits few side effects and does not significantly influence insulin resistance Objective Ethinylestradiol ( EE ) combined with the anti and rogenic progestin cyproterone acetate ( CPA ) is a possible treatment in polycystic ovary syndrome ( PCOS ) . We investigated the impact of EE/CPA on lipid and carbohydrate metabolism in women with PCOS , who were otherwise healthy . Method The 31 women were separated into two groups paired by body mass index ( BMI ): Group A ( control , n = 15 ) were cycled with 10 mg medroxyprogesterone acetate ( MPA ) x 10 days ( Provera ® , Pharmacia & Upjohn ) every month for 3 months ; Group B ( n = 16 ) were treated with 35 μg EE/2 mg CPA ( Diane 35 ® , Schering ) for 3 months . Metabolic and hormonal conditions were similar in both groups . Results Group A showed no change in any hormone or metabolic parameter . Group B showed a significant decrease in free and rogen index ( −81 % ) and increase in sex hormone binding globulin ( + 639 % ) , a decrease in low density lipoprotein cholesterol ( −14 % ) and total cholesterol/high density lipoprotein ( HDL ) cholesterol index ( −19 % ) , and increases in HDL cholesterol ( + 23 % ) and triglycerides ( + 82 % ) ( p < 0.001 ) . Fasting insulin increased in 18 % , the glucose/insulin index worsened in 8 % , and the plasma glucose disappearance worsened in 12 % , with no statistical significance ( p = 0.092 , p = 0.308 and p = 0.237 , respectively ) . Conclusion Treatment of PCOS with EE/CPA induces important favorable changes regarding hormone parameters associated with hyper and rogenism , significant favorable changes in lipid profile except for triglyceride increase , and no significant change in carbohydrate metabolism ( measured by fasting insulin , glucose/insulin index and plasma glucose disappearance ) . MPA cycling does not change any of these parameters Polycystic ovary syndrome is the most common endocrinological problem associated with hirsutism . The objective of this study was to compare four different treatment modalities for hirsutism related to this syndrome . Pelvic ultrasonography was performed on all patients who were referred to our Reproductive Endocrinology Outpatient Clinic because of complaints of hirsutism . After exclusion of hyper and rogenism caused by endocrine abnormalities other than polycystic ovary syndrome , 141 patients were included in the study . Patients were divided into four groups in regard to the drug chosen for treatment . Group 1 ( n = 48 ) received low-dose combined oral contraceptive . Group 2 ( n = 65 ) was treated with cyproterone acetate 100 mg daily for the first 10 days of a 21-day cycle with an oral contraceptive containing 2 mg cyproterone acetate , Group 3 ( n = 12 ) with spironolactone ( 100 - 200 mg daily ) and Group 4 ( n = 16 ) with ketoconazole ( 400 mg daily ) . All patients were followed frequently with respect to side-effects , hirsutism scoring , and lipid and hormonal levels . All four drug regimens were effective in the treatment of hirsutism related to polycystic ovary syndrome , but the most effective seemed to be ketoconazole . The decrement level in hirsutism scoring was the largest in the ketoconazole group , followed by the cyproterone , oral contraceptive and spironolactone groups ( 34.6 + /- 2.2 % , 20.1 + /- 2.7 % , 18.1 + /- 2.7 % and 12.8 + /- 3.7 % , respectively , p < 0.05 ) . Although high-density lipoprotein-cholesterol levels increased in all groups , this increment was smaller in Group 4 than in Groups 1 and 2 ( 5.1 + /- 2.8 % , 34.1 + /- 5.5 % and 29.1 + /- 4.9 % , respectively , p < 0.05 ) , but not statistically different from that in Group 3 ( 22.3 + /- 5.9 % ) . The free testosterone levels decreased after treatment in all groups , but the decrement ratios did not differ significantly among groups , although the decrease in free testosterone levels with treatment seemed to be higher in the ketoconazole group than in Groups 1 , 2 and 3 ( 57.0 + /- 2.5 % , 22.7 + /- 10.2 % , 26.7 + /- 6.5 % and 9.5 + /- 19.9 % , respectively ) . In conclusion , ketoconazole seems to be an excellent alternative to more-recognized therapies , but its effect on lipoprotein profile requires further study , because the hyper and rogenism , and the other problems related to hyper and rogenism besides hirsutism , should also be treated The clinical signs and neuroendocrine features of adolescents with polycystic ovary syndrome ( PCOS ) resemble those found in adult women with PCOS . These adolescent patients are c and i date s for long-term treatment by one of the different therapeutic approaches that have been proposed . It is therefore essential that the treatment does not induce unfavorable metabolic effects . We investigated and compared the effects of cyproterone acetate ( CA ) and desogestrel ( D ) , as part of combined oral contraceptives ( COC ) , on lipid metabolism and hirsutism in adolescents with PCOS . Twenty-four girls with clinical signs of PCOS were recruited . They were all hyper and rogenic and euthyroid and had normal prolactin plasma levels . Non-classic congenital adrenal hyperplasia was ruled out by the ACTH stimulation test . Blood sample s were obtained for sex hormone binding globulin ( SHBG ) , total cholesterol ( TC ) , LDL cholesterol , HDL cholesterol , triglycerides ( TGs ) , apolipoproteins A-I , A-II , B , and lipoprotein ( a ) ( Lp(a ) ) measurements . After the initial examination , therapy was initiated in a r and omly selected order ( 12 and 12 patients were treated daily by 2 mg CA and 0.150 mg D , respectively , plus 0.035 and 0.030 mg ethinylestradiol , respectively ) . The degree of hirsutism and the lipid profile were reevaluated every 3 months after initiation of therapy for 1 year . Our data show that after 12 months of treatment with the D or CA COC , the Ferriman-Gallway hirsutism score decreased and TC and LDL-C increased . TGs and HDL-C were raised significantly in the CA COC group , whereas apolipoprotein A1 increased during D COC treatment . The atheromatic indices did not change . These data suggest that treatment of adolescent girls with PCOS is comparably effective with the two contraceptive formulations and that the desogestrel COC could be considered in the treatment of adolescent PCOS patients because it does not have side effects on lipid metabolism Women with polycystic ovary syndrome ( PCOS ) are insulin resistant , have insulin secretory defects , and are at high risk for glucose intolerance . We performed this study to determine the prevalence of glucose intolerance and parameters associated with risk for this in PCOS women . Two-hundred and fifty-four PCOS women , aged 14 - 44 yr , were prospect ively evaluated at 2 centers , 1 urban and ethnically diverse ( n = 110 ) and 1 rural and ethnically homogeneous ( n = 144 ) . The rural PCOS women were compared to 80 control women of similar weight , ethnicity , and age . A 75-g oral glucose challenge was administered after a 3-day 300-g carbohydrate diet and an overnight fast with 0 and 2 h blood sample s for glucose levels .  Diabetes was categorized according to WHO criteria . The prevalence of glucose intolerance was 31.1 % impaired glucose intolerance ( IGT ) and 7.5 % diabetes . In nonobese PCOS women ( body mass index , < 27 kg/m2 ) , 10.3 % IGT and 1.5 % diabetes were found . The prevalence of glucose intolerance was significantly higher in PCOS vs. control women ( chi2 = 7.0 ; P = 0.01 ; odds ratio = 2.76 ; 95 % confidence interval = 1.23 - 6.57 ) . Variables most associated with postchallenge glucose levels were fasting glucose levels ( P < 0.0001 ) , PCOS status ( P = 0.002 ) , waist/hip ratio ( P = 0.01 ) , and body mass index ( P = 0.021 ) . The American Diabetes Association criteria applied to fasting glucose significantly underdiagnosed diabetes compared to the WHO criteria ( 3.2 % vs. 7.5 % ; chi2 = 4.7 ; P = 0.046 ; odds ratio = 2.48 ; 95 % confidence interval = 1.01 - 6.69 ) . We conclude that 1 ) PCOS women are at significantly increased risk for IGT and type 2 diabetes mellitus at all weights and at a young age ; 2 ) these prevalence rates are similar in 2 different population s of PCOS women , suggesting that PCOS may be a more important risk factor than ethnicity or race for glucose intolerance in young women ; and 3 ) the American Diabetes Association diabetes diagnostic criteria failed to detect a significant number of PCOS women with diabetes by postchallenge glucose values OBJECTIVE We evaluated the hypothesis that metformin would improve signs and symptoms of polycystic ovary syndrome ( PCOS ) in adolescents as compared to oral contraceptive pills ( OCP ) and have a favorable effect on obesity . STUDY DESIGN Thirty-five obese , post-menarchal , non-sexually active adolescents aged 12 - 21 years with PCOS and hyperinsulinism were r and omly assigned to receive either OCP or metformin for 6 months . RESULTS There was a significant decrease in BMI in the two groups over time , from 40.1 to 38.6 in the OCP group , and 37.3 to 36.3 in the metformin group , p = 0.0026 , but no significant difference in the degree of change between the two groups . Both groups had decreased free testosterone ( OCP : 1.8 pg/ml to 0.96 pg/ml ; metformin : 2.1 pg/ml to 1.6 pg/ml ) , p < 0.0001 , and improvements in insulin resistance as evidence d by increased glucose/insulin ( G/I ) ratio ( p < 0.005 ) and increased QUICK1 scores ( p < 0.0005 ) . No significant differences in response to treatment were found between the metformin and OCP groups in outcome variables . CONCLUSION Adolescents with PCOS treated with metformin or OCP experienced similar beneficial outcomes including reduction in and rogen levels , weight loss , and increased insulin sensitivity . The choice of a treatment agent for long-term use will depend on safety profiles , therapeutic goals and patient adherence BACKGROUND Follistatin levels have recently been considered as a marker for inflammation . Our objective was to evaluate the level of circulating follistatin and high-sensitivity C-reactive protein ( hsCRP ) in women with polycystic ovary syndrome ( PCOS ) after oral contraceptive ( OC ) treatment . METHODS A total of 56 Taiwanese women with PCOS were enrolled in this prospect i ve observational study in which they were treated for 3 months with OCs ( ethinyl estradiol-cyproterone acetate ) . Blood sample s were taken at baseline after treatment during the withdrawal bleed .  Body mass index ( BMI ) , lipid profiles , plasma follistatin , hsCRP , fasting glucose , insulin for the homeostasis model assessment of insulin resistance ( HOMA-IR ) and hormone profiles were measured and analyzed . RESULTS Total testosterone , free and rogen index ( FAI ) , dehydroepi and rosterone sulfate ( DHEAS ) , follicle-stimulating hormone ( FSH ) , luteinizing hormone ( LH ) and estradiol levels were significantly lower , but total cholesterol , low-density lipoprotein cholesterol ( LDL-C ) , high-density lipoprotein cholesterol ( HDL-C ) , triglycerides , circulating follistatin and hsCRP were significantly higher than baseline in women with PCOS after treatment with OCs . An elevation of fasting insulin , HOMA-IR and hsCRP after OC treatment was more evident in non-obese than obese women , whereas the elevation of follistatin was significant in both obese and non-obese women . Follistatin and hsCRP levels all showed significant correlations with each other at baseline and after treatment . The differences in follistatin and hsCRP levels from baseline to after OC treatment were significantly associated with the difference in triglyceride levels . CONCLUSIONS Both hsCRP and follistatin levels increase after OC treatment in women with PCOS . Follistatin seems more sensitive than hsCRP alone to represent the aggravated low- grade inflammatory status after OC treatment in obese and non-obese women with PCOS OBJECTIVE To determine the ultrasonographic and lipid changes in women with polycystic ovary syndrome ( PCOS ) according to the type of hormonal treatment . STUDY DESIGN Thirty-two women with clinical and ultrasonographic diagnosis of PCOS were studied and r and omly distributed in one or another treatment group . Group I : chlormadinone ( 2 mg/day for 5 days every month ) ( n = 16 ) and Group II : ethinylestradiol 35 micrograms plus desogestrel 150 mg ( 21 days every month ) ( n = 16 ) . At baseline and at third month a pelvic ultrasound was done to assess the number and size of follicles , also total cholesterol and triglycerides were measured . RESULTS In both groups a significant decrease was found in the number of follicles in both ovaries , but only in group II there was a significant decrease in follicular size in both ovaries . No differences were found between the groups in the number of follicles or in the final follicular size . In both groups , a significant decrease was found in total cholesterol levels , without changes in triglycerides levels . CONCLUSION Only combined therapy decreased follicular size . So the type of treatment should be based on patient expectations such as sexual activity , or for control of and rogen excess
BACKGROUND Polycystic ovary syndrome ( PCOS ) is the most common endocrine disorder of young women .
First-line treatment is often the oral contraceptive pill ( OC ) , but evidence suggests that OC may worsen metabolic outcomes in this population .
We undertook this meta- analysis of observational studies and cohorts from within r and omized controlled studies to investigate the association between OC use and dysglycemia , dyslipidemia and insulin resistance ( IR ) in women with PCOS .