Skin improvement with two different oestroprogestins in patients affected by acne and polycystic ovary syndrome: clinical and instrumental evaluation. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study The effect of ethinyl estradiol–cyproterone acetate treatment on homocysteine levels in women with polycystic ovary syndrome Effect of oral contraceptive containing ethinyl estradiol combined with drospirenone vs. desogestrel on clinical and biochemical parameters in patients with polycystic ovary syndrome. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions Comparison of two oral contraceptive forms containing cyproterone acetate and drospirenone in the treatment of patients with polycystic ovary syndrome: a randomized clinical trial Efficacy of a new oral contraceptive containing drospirenone and ethinyl estradiol in the long-term treatment of hirsutism. Androgen and lipid profiles in adolescents with polycystic ovary syndrome who were treated with two forms of combined oral contraceptives. Treatment of hirsutism with combined pill containing drospirenone Effect of ethinylestradiol/cyproterone acetate on endothelial function in young non-obese women with polycystic ovary syndrome: a pilot study Effect of four different oral contraceptives on various sex hormones and serum-binding globulins. 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. Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone in patients with polycystic ovary syndrome. Efficacy of an oral contraceptive containing drospirenone in the treatment of women with polycystic ovary syndrome The effect of different contraceptive treatments on the serum concentration of dehydroepiandrosterone sulfate. Effect of oral contraceptives on markers of hyperandrogenism and SHBG in women with polycystic ovary syndrome. The impact of oral contraceptives and metformin on anti-Müllerian hormone serum levels in women with polycystic ovary syndrome and biochemical hyperandrogenemia Effect of two oral contraceptives containing ethinylestradiol and gestodene or norgestimate upon androgen parameters and serum binding proteins. Diurnal rhythm and effects of oral contraceptives on serum dehydroepiandrosterone sulfate (DHEAS) are related to alterations in serum albumin rather than to changes in adrenocortical steroid secretion Increased follistatin levels after oral contraceptive treatment in obese and non-obese women with polycystic ovary syndrome.
BACKGROUND Despite it is accepted that acne is mostly caused by an hyper-responsiveness of the pilo-sebaceous unit to normal circulating and rogen hormones , in a few patients , especially women , acneic lesions can be associated with increased serum and rogen levels ( hyper and rogenism ) , of which polycystic ovary syndrome ( PCOS ) is the most common cause . In women with acne and proven PCOS therapy with estroprogestins ( EPs )  can be an excellent option . OBJECTIVE The aim of the study was to assess the effects of two estroprogestins ( EPs ) , ethinyl-estradiol ( EE ) 30 mcg/drospirenone ( DRSP ) 3 mg , and ethinyl-estradiol ( EE ) 30 mcg/chlormadinone acetate ( CMA ) 2 mg , both on increased serum and rogen levels and on several skin parameters in women affected by mild to severe acne and polycystic ovary syndrome ( PCOS ) . METHODS Fifty-nine women were r and omized to receive EE/DRSP ( n = 32 ) or EE/CMA ( n = 27 ) for six months . Evaluation of serum and rogen levels , grading of acne and hirsutism ( respectively with Pillsbury and Ferriman-Gallwey score ) and non-invasive assessment of skin hydration , transepidermal water loss ( TEWL ) and skin homogeneity were performed at baseline , at 3 and 6 months ( end of treatment ) . RESULTS Both treatments were well tolerated and showed a significant improvement of skin and hormonal parameters , although EE/DRSP showed a more potent effect on acne and seborrhea . CONCLUSIONS Estroprogestins represent an effective and safe treatment in women with acne and polycystic ovary syndrome ( PCOS ) . Nevertheless , the combination EE 30 mcg/DRSP 3 mg appears to be a more potent therapeutic option Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement . After an expert meeting in January 2007 , the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement . This up date improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition , such as selective outcome reporting bias . This explanatory and elaboration document-intended to enhance the use , underst and ing , and dissemination of the CONSORT statement-has also been extensively revised . It presents the meaning and rationale for each new and up date d checklist item providing examples of good reporting and , where possible , references to relevant empirical studies . Several examples of flow diagrams are included . The CONSORT 2010 Statement , this revised explanatory and elaboration document , and the associated website ( www.consort-statement.org ) should be helpful re sources to improve reporting of r and omised trials Background Despite the heavy burden and impact of the polycystic ovary syndrome ( PCOS ) in reproduction and public health , estimates regarding its prevalence at community levels are limited . We aim ed to ascertain prevalence of PCOS in a community based sample using the National Institute of Health ( NIH ) , the Rotterdam consensus ( Rott . ) and the And rogen Excess Society ( AES ) criteria . Methods Using the stratified , multistage probability cluster sampling method , 1126 women were r and omly selected from among reproductive aged women of different geographic regions of Iran . PCOS were diagnosed using universal assessment of ultrasonographic parameters , hormonal profiles and clinical histories . Results The mean + /- SD of age of study population was 34.4 + /- 7.6 years . Estimated prevalence of idiopathic hirsutism was 10.9 % ( 95 % CI : 8.9 - 12.9 % ) ; 8.3 % of women had only oligo/anovulation and 8.0 % had only polycystic ovaries . The prevalence of PCOS was 7.1 % ( 95 % CI : 5.4 - 8.8 % ) using the NIH definition , 11.7 % ( 95 % CI : 9.5 - 13.7 % ) by AES criteria and 14.6 % ( 95 % CI : 12.3 - 16.9 % ) using the Rott definition . Conclusions At community level , widespread screening of Rotterdam criteria will increase the estimated prevalence of PCOS over twofold . Establishing an explicit and contemporaneous method for definition and screening of each PCOS criteria has important investigational implication s and increase the comparability of published research 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 BACKGROUND A prospect i ve r and omized trial was conducted to compare efficacy of a drospirenone-containing combined oral contraceptives ( COC ) with desogestrel-containing COC in women with polycystic ovary-syndrome ( PCOS ) not desirous of child-bearing . STUDY DESIGN Sixty women were r and omized into study group [ ethinylestradiol ( EE ) 30 mcg+drospirenone 3 mg ] and control group ( EE 30 mcg+desogestrel 150 mcg ) , treated for 6 months and followed up at 1 month , 3 months , 6 months , during treatment and 3 and 6 months post-treatment . Acne and hirsutism scoring , bodyweight , body mass index ( BMI ) , blood pressure ( BP ) , ultrasound parameters , lipid profile , glycemic profile and hormonal profile were compared . RESULTS Cycles were regular in both groups during treatment . Effect of regular cycles persisted in 44.83 % ( 13/30 ) vs. 17.24 % ( 5/30 ) in study vs. control group at 6 months post-treatment with 33.3 % decreased hirsutism score in the study group ( versus no change in control group ) even at 6 months after stopping treatment . With treatment , BMI fell by 0.52 kg/m(2 ) in the study group ; systolic and diastolic BP fell in the study group while it rose in the control group . Low-density lipoprotein significantly decreased and high-density lipoprotein was elevated in the study group ( p<.05 ) . The study group showed a significant fall in fasting/postpr and ial blood sugar and insulin and total testosterone against a rise in the control group . CONCLUSION In women with PCOS , a drospirenone containing COC has better outcome in terms of persistent regular cycles , anti and rogenic effect , fall in BMI and BP , better lipid profile , favorable glycemic and hormonal profile than desogestrel-containing COC Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Purpose To compare the effects of combined oral contraceptives ( OCs ) containing cyproterone acetate and drospirenone in the treatment of polycystic ovary syndrome ( PCOS ) . Methods Fifty-two patients with PCOS were r and omized in two groups : group A ( n = 26 ) received 0.035 mg ethinyl estradiol + 2 mg cyproterone acetate and group B ( n = 26 ) received 0.03 mg ethinyl estradiol + 3 mg drospirenone-containing OCs for 12 months . Baseline clinical features including body mass index , waist to hip ratio ( WHR ) , and modified Ferriman-Gallwey ( mFG ) score were noted . Baseline biochemical parameters included and rogen profile , carbohydrate metabolism , lipid profile , and oxidative stress . The percentages of changes for all parameters were compared . Results The groups were comparable regarding the baseline characteristics . WHR decreased significantly from baseline ( −4 % [ −31 to 35 ] ) in group B when compared to group A ( 0 % [ −11 to 14 ] ) ( P = 0.033 ) . The total mFG score decreased significantly from baseline ( −35 % [ −71 to 10 ] ) in group A when compared to group B ( −18 % [ −72 to 30 ] ) ( P = 0.035 ) . Changes in and rogen hormone profile were comparable except DHEA-SO4 ( −32 % [ −53 to 15 ] in group B vs. −10 % [ −49 to 63 ] in group A ; P = 0.046 ) . The effects of the drugs were similar regarding carbohydrate metabolism , lipid profile , and oxidative stress parameters . Conclusions Cyproterone acetate containing OCs seem to be more effective to treat clinical hirsutism in patients with PCOS after 12 months of treatment OBJECTIVE This study represents long term clinical and biochemical results and the response of different body parts to medical therapy with oral ethinyl estradiol/drospirenone combination in hirsute patients with or without polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve , open , controlled clinical study . SETTING Out patients at Erciyes University Medical School . PATIENT(S ) Fifty women with moderate to severe hirsutism were recruited . Two women were lost to follow-up . INTERVENTION(S ) Women were treated with 3 mg of drospirenone and 30 microg of ethinyl estradiol for 12 cycles . MAIN OUTCOME MEASURE(S ) Hirsutism was assessed at 6-month intervals using the Ferriman-Gallwey ( F-G ) scoring system . Serum FSH , LH , total and free testosterone ( T ) , and rostenedione ( A ) , dehydroepi and rosterone sulfate ( DHEAS ) , estradiol ( E2 ) , and sex-hormone binding globulin ( SHBG ) levels at 6 and 12 months of therapy were compared with baseline values . RESULT ( S ) Total mean FG score declined by 67 % and 78 % after 6 and 12 months , respectively . Improvement was most prominent on the chest and abdomen , followed by the upper lip and chin . The lowest effect was observed on the back and arms . Serum levels of total and free T and A decreased , whereas SHBG levels increased significantly after 6 and 12 months when compared with baseline levels . CONCLUSION ( S ) Drospirenone/ethinyl estradiol combination exerts significant anti and rogenic activity and is effective in improving  facial hirsutism .  The beneficial effect is most obvious after six cycles and continues thereafter at a slower rate 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 The aim of the present study was to evaluate the biochemical and clinical effects of the combined pill consisting of ethinyl estradiol ( EE ) and drospirenone ( DRSP ) in hirsute patients . Fifty-two adolescents or young women from Greece were treated with 30 μg EE and 3 mg DRSP for 1 year . Hirsutism was evaluated by the Ferriman – Gallway ( FG ) score in the initial visit and at 3 , 6 and 12 months . Follicle-stimulating hormone , luteinizing hormone , etradiol , free and total testosterone ( T ) , sex hormone-binding globulin ( SHBG ) , and rostenedione and dehydroepi and rosterone sulfate were determined at the same intervals . Hirsutism improved and FG scores reduced to 77.4 % , 67.2 % and 51.8 % at 3 , 6 and 12 months , respectively . Plasma SHBG levels rose , while free and total T levels reduced from the third month onwards . In conclusion , the EE/DRSP pill improves hirsutism in women via anti and rogenic and antimineralocorticoid action . The biochemical manifestations of hyper and rogenism are also improved Background . Combined oral contraceptives are used in polycystic ovary syndrome ( PCOS ) women for the treatment of hyper and rogenism and menstrual cycle disturbances . Aim . To assess the effect of ethinylestradiol and cyproterone acetate ( EE/CA ) on endothelial function in young , non-obese PCOS women in a pilot study . Methods . Thirteen young , non-obese PCOS women ( 20.9 ± 3.7 years , 23.0 ± 4.0 kg/m2 ) received 35 mcg EE & 2 mg CA for 6 months . Fourteen age- and body mass index ( BMI ) -matched healthy women served as controls . Endothelial function assessed by brachial artery flow-mediated dilation ( FMD ) , indices of hyper and rogenism , and insulin resistance were studied at baseline and 6-month follow-up . Results . FMD was impaired in PCOS compared to control women ( 4.67 ± 2.38 % vs. 10.12 ± 3.19 % , p < 0.001 ) , but increased significantly following EE/CA ( 9.99 ± 2.11 % , p < 0.001 vs. baseline ) , reaching normal values ( p = NS vs. controls ) . EE/CA also significantly decreased hyper and rogenism indices and increased total and HDL cholesterol and triglycerides ( p < 0.05 vs. baseline ) . The only independent predictor of treatment-induced FMD improvement in PCOS women was the decrease in free and rogen index . Conclusions . Treatment with combination of estrogens and anti and rogens reverses endothelial dysfunction in young , non-obese PCOS women mainly via improving hyper and rogenism . Further research is needed to investigate whether this treatment may also reduce cardiovascular risk in these women In a double-blind , controlled , r and omized , four-arm , bicentric clinical study , the effect of four oral contraceptives ( OCs ) on various hormone parameters and serum-binding globulins was investigated . Four groups with 25 volunteers each ( 18 - 35 years of age ) were treated for six cycles with monophasic combinations containing 21 tablets with either 30 microg ethinylestradiol ( EE ) + 2 mg dienogest ( DNG ) ( 30EE/DNG ) , 20 microg EE + 2 mg DNG ( 20EE/DNG ) , 10 microg EE + 2 mg estradiol valerate ( EV ) + 2 mg DNG ( EE/EV/DNG ) or 20 microg EE + 100 microg levonorgestrel ( LNG ) ( EE/LNG ) . The study was completed by 91 subjects . Blood sample s were taken after at least 12 h of fasting on Day 21 - 26 of the preceding control cycle and on Day 18 - 21 of the first , third and sixth treatment cycle . The serum concentrations of free testosterone were significantly decreased by about 40 - 60 % in all four groups , while those of dehydroepi and rosterone sulfate ( DHEAS ) showed a time-dependent decrease during treatment . Except for EE/EV/DNG , which increased prolactin significantly during the third and sixth cycles , no change was observed with the EE-containing preparations . There was a significant increase in the levels of serum-binding globulins during treatment , which differed according to the composition of the OCs used . The rise in sex hormone-binding globulin ( SHBG ) was highest during intake of 30EE/DNG ( + 320 % ) and lowest with EE/LNG ( + 80 % ) , while the effect of 20EE/DNG and EE/EV/DNG was similar ( + 270 % ) . The thyroxine-binding globulin ( TBG ) levels increased significantly , by 50 - 60 % , during treatment with the DNG-containing formulations , while the effect of EE/LNG was less significant ( + 30 % ) . The rise in corticosteroid-binding globulin ( CBG ) , which occurred in all groups , was most pronounced in women treated with 30EE/DNG ( + 90 % ) and least with EE/EV/DNG ( + 55 % ) , indicating a strong influence of EE and no effect of the progestogen component . In all treatment groups , the frequency of intracyclic bleeding rose in the first treatment cycle and decreased thereafter . Cycle control was significantly better with 30EE/DNG or EE/LNG than with 20EE/DNG or EE/EV/DNG . There was no significant change in blood pressure , body mass index or pulse rate throughout the study . In conclusion , the DNG-containing OCs caused a higher rise in SHBG and TBG levels than the LNG-containing preparation . The effects on CBG suggest a lesser hepatic effect of 2 mg EV as compared to 20 or 30 microg EE . In contrast to EE , the use of estradiol in OCs appeared to increase prolactin release , while the cycle control was better with the OC containing 30 microg EE 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 To compare the effects of oral contraceptive pills containing desogestrel , cyproterone acetate , and drospirenone , in polycystic ovary syndrome ( PCOS ) , after 6 and 12 months of therapy . DESIGN Double-blind r and omized controlled trial . SETTING Gynecologic clinic of the first author . PATIENT(S ) Women ( n = 171 ) with PCOS ( And rogen Excess Society criteria , 2006 ) . INTERVENTION(S ) The three-arm trial involved 58 , 56 , and 57 cases in desogestrel , cyproterone acetate , and drospirenone groups , respectively . Body mass index , abdominal circumference , hirsutism score ( modified Ferriman Galwey ) , acne and acanthosis nigricans scores , and blood pressure were noted . Blood levels of total T , sex hormone-binding globulin , fasting glucose , and fasting insulin were measured . Free and rogen index , glucose-insulin ratio , and homeostasis model assessment -insulin resistance were calculated . Follow-up was after 6 and 12 months of treatment . MAIN OUTCOME MEASURE(S ) Primarily , absolute change in the Free And rogen Index score between the three groups and , secondarily , changes in the clinical and other hormonal and biochemical parameters were studied . RESULT ( S ) Six months of treatment showed similar effects . After 12 months , cyproterone acetate significantly decreased the modified Ferriman Galwey score ( change = -5.29 ) compared with both desogestrel ( change = -1.69 ) and drospirenone ( change = -2.12 ) ; cyproterone acetate significantly increased sex hormone-binding globulin ( change = 142.91 ) compared with desogestrel ( change = 99.53 ) ; drospirenone significantly increased sex hormone-binding globulin ( change = 131.52 ) compared with desogestrel ; and cyproterone acetate significantly decreased the Free And rogen Index ( change = -10.57 ) compared with desogestrel ( change = -5.58 ) . CONCLUSION ( S ) No difference in effects after 6 months . At 12 months , cyproterone acetate showed the strongest anti and rogen activities . Effects on metabolic parameters were identical . CLINICAL TRIAL REGISTRATION NUMBER CTRI/2010/091/000332 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 Twenty-six healthy , non-hirsute women had antecubital venous blood obtained before and during treatment with various  contraceptive steroids  for the measurement of dehydroepi and rosterone sulfate ( DHEA-S ) .  Six of the women were r and omized to receive Ortho Novum 1/35 ( O/N ) , 7 were assigned to Ovcon 35 ( OV ) , and another five received Nordette ( N ) . The 6 women ingesting O/N as well as the 7 receiving OV had significant decreases in serum concentrations of DHEA-S ( p less than 0.05 ) . The percentage of decrease in DHEA-S in the O/N group ( 39 + /- 6 % ) and in the OV group ( 30 + /- 5 % ) was not statistically different . The group receiving N showed no changes from baseline measurements . Serum sample s from another 8 women who had received subcutaneous implants of levonorgestrel ( 1-Ng ) were obtained . No significant changes occurred in serum DHEA-S between baseline and six-month sample s. The data that 1-Ng alone and the combination of 1-Ng and ethinylestradiol did not change DHEA-S levels suggest that 1-Ng does not affect adrenal and rogen secretion . Because N , O/N and OV contain similar quantities of ethinylestradiol , these results indicate that norethindrone , but not 1-Ng , has a major suppressive effect upon adrenal and rogen secretion BACKGROUND This r and omized study 's aim was to compare the effect of four oral contraceptives ( OCs ) containing 30 mcg of ethinylestradiol ( EE ) and different progestogens [ drospirenone , ( DRSP ) , chlormadinone acetate ( CMA ) , desogestrel ( DSG ) , gestodene ( GSD ) ] on biochemical and hormonal parameters of hyper and rogenism and sex hormone-binding globulin ( SHBG ) in women with polycystic ovary syndrome ( PCOS ) . STUDY DESIGN Forty women with PCOS ( age 16 - 35 years ) were recruited and r and omly assigned to one of four treatment groups of 10 women each , treated , respectively , with 3 mg DRSP/30 mcg EE ( Yasmin , Bayer Shering ) , 2 mg CMA/30 mcg EE ( Belara , Grunenthal ) , 75 mcg GSD/30 mcg EE ( Minulet , Wyeth Lederle ) and 150 mcg DSG/30 mcg EE ( Practil 21 , Organon Italia ) . Blood sample s were obtained on day 6 - 8 of the control cycle and day 6 - 8 of the third treatment cycle for assay of the following hormones : and rosteredione ( A ) , total testosterone ( T ) , free T , SHBG , dehydroepi and rosterone sulphate ( DHEAS ) . RESULTS In all groups , mean concentrations of free T , total T and A dropped by 40 - 60 % , and concentrations of DHEAS dropped by 20 - 50 % . Formulations with DRSP and CMA caused a greater reduction of and rogens and a progressive increase in serum concentrations of SHBG than those with DSG and GSD . CONCLUSIONS Clinical studies need to be performed to determine effects of these OCs upon clinical signs of hyper and rogenism Objective . To assess the impact of metformin and of two different oral contraceptives ( OCs ) containing cyproterone acetate and drospirenone , on serum anti-Müllerian hormone ( AMH ) levels , in a cohort of women with polycystic ovary syndrome ( PCOS ) with hyper and rogenism . Design . Prospect i ve r and omised study . Setting . Division of Endocrinology and Human Reproduction , Aristotle University of Thessaloniki . Patients . Forty-five ( 45 ) women with PCOS diagnosed according to the criteria proposed in 1990 by the NIH . Interventions . Women with PCOS were r and omised into three groups , all treated for 6 months : Group A received an OC containing 35 μg ethinylestradiol plus 2 mg cyproterone acetate , Group B received an OC containing 30 μg ethinylestradiol plus 3 mg drospirenone and Group C received metformin 850 mg × 2 . Main outcome measure(s ) . Anti-Müllerian hormone levels were measured by a specific ELISA . Results . AMH was significantly decreased under treatment with 35 μg ethinylestradiol plus 2 mg cyproterone acetate ( p = 0.002 at 3 months and p < 0.001 at 6 months ) . Treatment with 30 μg ethinylestradiol plus 3 mg drospirenone , and treatment with metformin 850 mg × 2 did not significantly affect serum AMH levels . AMH was significantly decreased under OCs treatment compared to metformin 850 mg × 2 ( p = 0.005 ) . Conclusion ( s ) . AMH serum levels were significantly decreased under treatment with 35 μg ethinylestradiol plus 2 mg cyproterone acetate , due to decrease in and rogens and suppression of gonadotropins The effect of a triphasic oral contraceptive containing ethinylestradiol and gestodene ( EE/GSD ) on various serum hormonal parameters was compared with that of a monophasic formulation containing 35 micrograms ethinylestradiol and 250 micrograms norgestimate ( EE/NGM ) . Blood sample s were collected from 46 women on days 2 , 11 , and 21 of the preceding control cycle and of the third , sixth and twelfth treatment cycle . There was no significant difference in the influence on any hormonal parameter between both formulations . Both EE/GSD and EE/NGM caused a time-dependent suppression of serum dehydroepi and rosterone sulphate ( DHEA-S ) by 20 - 30 % ( p < 0.01 ) and a reduction of 5 alpha- and rostane-3 alpha , 17 beta-diol glucuronide by 50 - 60 % ( p < 0.01 ) during each treatment cycle , while and rostenedione levels were reduced by 25 % ( p < 0.01 ) . There was also a significant decrease in the levels of total testosterone by 30 - 35 % ( p < 0.01 ) and free testosterone by 60 % ( p < 0.01 ) , while sex hormone-binding globulin ( SHBG ) was increased by 200 - 240 % on days 11 and 21 ( p < 0.01 ) . During the pill-free interval the SHBG levels were reduced to a certain degree but remained elevated by 100 % as compared to the pretreatment values . The serum levels of corticosteroid-binding globulin ( CBG ) which is known to be influenced only by the estrogenic component of combination pills , increased significantly by 170 % ( p < 0.01 ) during each treatment cycle . During the pill-free interval of 7 days , the CBG levels decreased but were still elevated by 90 - 100 % as compared to the control cycle . Similarly , the serum levels of cortisol were significantly elevated by 110 - 140 % ( p < 0.01 ) during treatment with both preparations . The results demonstrate a profound suppression of and rogen levels and peripheral and rogen metabolism Dehydroepi and rosterone sulfate ( DHEAS ) , which is of almost exclusive adrenal origin , is important for the and rogen status in women and prepubertal children , and DHEAS assays are used in the investigation of hyper and rogenism . There are conflicting reports concerning a diurnal variation in serum DHEAS . Although of adrenocortical origin , serum DHEAS levels are decreased by oral contraceptives ( OCs ) . DHEAS is strongly bound to serum albumin and has a very low metabolic clearance rate . The present study was performed in order to investigate whether a diurnal variation in serum DHEAS exists and , if so , whether this diurnal variation and the decreased DHEAS levels following OC use are related to alterations in adrenocortical steroids or to changes in serum albumin . Serum concentrations of DHEAS , dehydroepi and rosterone ( DHEA ) , cortisol and albumin were determined in blood sample s taken every half hour over a 24-h period in 10 healthy women before and during use of combined OCs .  Significant and frequently synchronous diurnal variations in serum DHEAS and albumin were found before as well as during OC use . These variations were not synchronous with the diurnal variation in DHEA . OCs significantly decreased serum DHEAS and albumin levels . A multiple regression analysis showed changes in albumin to be the most decisive factor for the diurnal variation as and for OC-induced changes in DHEAS . Changes in serum DHEAS during the day and following OC use are related to alterations in its main binding protein , serum albumin , rather than to changes in adrenocortical steroid secretion 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
INTRODUCTION Nowadays , selection of COCs with maximum anti and rogenic effects is one the main issues in treatment of women with polycystic ovary syndrome ( PCOS ) .
OBJECTIVE This systematic review and meta- analysis aim ed to compare the effects of COCs on the clinical and biochemical parameters of hyper and rogenism ( HA ) in patients with PCOS .