Skin improvement with two different oestroprogestins in patients affected by acne and polycystic ovary syndrome: clinical and instrumental evaluation. Polycystic ovary syndrome and cardiovascular risk in young patients treated with drospirenone-ethinylestradiol or contraceptive vaginal ring. A prospective, randomized, pilot study. Antimüllerian hormone levels decrease in women using combined contraception independently of administration route. Effect of oral contraceptive containing ethinyl estradiol combined with drospirenone vs. desogestrel on clinical and biochemical parameters in patients with polycystic ovary syndrome. Effect of Short-Term Standard Therapeutic Regimens on Neuropeptide Y and Adipose Tissue Hormones in Overweight Insulinresistant Women with Polycystic Ovary Syndrome Serum uric acid concentration as non-classic cardiovascular risk factor in women with polycystic ovary syndrome: effect of treatment with ethinyl-estradiol plus cyproterone acetate versus metformin. The effects of 2 mg chlormadinone acetate/30 mcg ethinylestradiol, alone or combined with spironolactone, on cardiovascular risk markers in women with polycystic ovary syndrome. A prospective randomized trial comparing low-dose ethinyl estradiol and drospirenone 24/4 combined oral contraceptive vs. ethinyl estradiol and drospirenone 21/7 combined oral contraceptive in the treatment of hirsutism. Comparison of the clinical efficacy of flutamide and spironolactone plus ethinyloestradiol/cyproterone acetate in the treatment of hirsutism: A randomised controlled study Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone in patients with polycystic ovary syndrome. Metformin, naltrexone, or the combination of prednisolone and antiandrogenic oral contraceptives as first-line therapy in hyperinsulinemic women with polycystic ovary syndrome. Six-Month Evaluation of the Benefits of the Low-Dose Combined Oral Contraceptive Chlormadinone Acetate 2 mg/Ethinylestradiol 0.03 mg in Young Women Effects of an antiandrogenic oral contraceptive pill compared with metformin on blood coagulation tests and endothelial function in women with the polycystic ovary syndrome: influence of obesity and smoking. Pregnancy in women with polycystic ovary syndrome: the effect of different phenotypes and features on obstetric and neonatal outcomes. 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 Effects of an oral contraceptive containing 30 mcg ethinyl estradiol and 2 mg dienogest on thyroid hormones and androgen parameters: conventional vs. extended-cycle use.
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 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 . SETTING Bologna University School of Medicine . PATIENT(S ) Thirty-seven women with polycystic ovary syndrome ( PCOS ) were r and omly su bmi tted 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 . INTERVENTION(S ) The effect of treatments was assessed after 6 months of therapy . MAIN OUTCOME MEASURE(S ) 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 sample s were drawn for testing biochemical and hormonal parameters and nitrites/nitrates . RESULT ( S ) Both treatments improved hirsutism , hyper and rogenemia , 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 . CONCLUSION ( S ) Vaginal hormonal contraception appears to be preferable to oral ethinylestradiol + drospirenone administration in hyperinsulinemic patients with PCOS OBJECTIVE To compare the effects of continuous use of oral ( OC ) , transdermal , and vaginal combined contraceptives on the pituitary-ovarian axis and inhibition of follicular development . DESIGN Spin-off study of a prospect i ve , r and omized trial . SETTING University clinic . PATIENT(S ) Forty-two of 54 healthy women completed the study . INTERVENTION(S ) Treatment with combined OCs ( ethinyl E2 [ EE ] and desogestrel ) , transdermal patches ( EE and norelgestromin ) , or vaginal rings ( EE and etonogestrel ) for 9 weeks continuously . Blood sampling was performed before and at 5 and 9 weeks of treatment . MAIN OUTCOME MEASURE(S ) Changes in serum hormone levels induced by combined contraceptives . RESULT ( S ) Serum antimüllerian hormone ( AMH ) , FSH , inhibin B , LH , and E2 levels had decreased significantly in all study groups after 9 weeks of treatment . Significant declines were already detected after 5 weeks ' use of combined contraceptives with regard to all hormone levels apart from those of serum AMH , where the decrease between baseline and 5 weeks was only moderate . Between groups , serum levels of AMH , inhibin B , LH , and E2 were comparable at baseline and after 5 and 9 weeks of treatment . CONCLUSION ( S ) The decrease of serum AMH levels during the use of all combined contraceptives indicates that folliculogenesis is arrested independently of administration route . CLINICAL TRIAL REGISTRATION NUMBER NCT01087879 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 Effect of Short-Term St and ard Therapeutic Regimens on Neuropeptide Y and Adipose Tissue Hormones in Overweight Insulinresistant Women with Polycystic Ovary Syndrome Aim : The study was aim ed at elucidating the influence of a 3-month treatment with routine therapeutic regimens - oral hormonal contraceptives ( OHC ) with anti and rogenic activity ( a st and ard combination of ethynil estradiol 35 μg plus cyproterone acetate 2 mg ) in combination with insulin sensitizing agents - metformin ( Group I ) and rosiglitazone ( Group II ) on adipose tissue hormones and hypothalamic neuropeptide Y ( NPY ) in women with polycystic ovary syndrome . Patients and methods : The study included 66 overweight insulin resistant women with PCOS according to the recent ESHRE-ASRM criteria r and omized into 2 age-matched therapeutic groups . Results : Significant decrease of leptin ( P < 0.01 ; P = 0.001 , resp . ) , resistin ( P < 0.01 ; P < 0.01 , resp . ) , tumour necrosis factor α ( TNFα ) ( P = 0.001 ; P < 0.001 , resp . ) , and NPY ( P < 0.05 ; P < 0.001 , resp . ) was observed in both groups after treatment . These findings were in parallel with a significant decrease in the anthropometric parameters of body weight in the metformin group only . No significant changes in hormonal characteristics of the groups were found except for a significant decrease in and rostenedione and DHEA-S ( P < 0.05 ) in the metformin group and in 17-OH-progesterone ( P < 0.05 ) in the rosiglitazone  group . HDL-cholesterol rose and diastolic blood pressure fell significantly ( P < 0.05 ) in the metformin group . Conclusion : Our data suggest beneficial effects of the treatment on potential cardiovascular risk in insulin resistant PCOS women . Эффект кратковременного при-менения стандартных терапев-тических режимов на нейропетид y и на гормоны жировой ткани у инсулин-резистентных женщин с поликистозным овариальным синдромом ( pcos ) и с избыточной массой тела Цель : Исследование ставит себе целью изучить эффект трехмесячного лечения с помощью рутин-ных терапевтических режимов ( оральные гормо-нальные контрацептивы ) , обладающих анти-андрогенной активностью ( стандартная комбинация - этинил эстрадиол 35 jug + ципротерон ацетат 2 mg ) в комбинации с метформином группа I и росиглитазоном - группа II на гормоны жировой ткани и на гипоталамический нейропептид Y ( NPY ) у женщин с PCOS . Пациенты и методы : Исследование охватывает 66 инсулин-резистентных женщин с PCOS и с избыточной массой тела . Диагноз поставлен по критериям ESHRE-ASRM ( рандомизация - две тера-певтические группы близкие по возрасту ) . Результаты : И в обеих группах после лечения отмечено сигнификантное уменьшение лептина ( Р < 0.01 ; Р = 0.001 , респ . ) , резистина ( Р < 0.01 ; Р < 0.01 , респ . ) , опухоли некротизирующего фактора a ( TNFa ) ( Р = 0.001 ; Р < 0.001 , респ . ) и NPY ( P < 0.05 ; Р < 0.001 , респ . ) . Эти результаты параллельны сигнификантному уменьшению антропометрических параметров массы тела только в группе женщин , леченных метформином . Не наблюдаются сигнифи-кантные изменения гормональных показателей и в обеих группах за исключением сигнификантного уменьшения андростерона и DHEA-S ( Р < 0.05 ) в группе , леченной метформином и 1 7-ОН-прогестерона ( Р < 0.05 ) в группе , леченной росиглитазоном . После лечения метформином HDL -холестерол повы-шается , а диастолическое артериальное давление сигнификантно снижается ( Р < 0.05 ) . Выводы : Полученные данные показывают благо- приятный эффект лечебных схем на потенциальные сердечно-сосудистые факторы риска у инсулин-резистентных женщин с PCOS BACKGROUND Serum uric acid levels have emerged as a cardiovascular risk factor , and interventions aim ed to decrease its level have been related with an improvement in clinical and non- clinical cardiovascular outcomes . METHODS Serum uric acid levels were measured in 40 polycystic ovary syndrome ( PCOS ) patients and 40 non-hyper and rogenic women matched for BMI and grade of obesity , and were followed-up in 34 PCOS patients who were r and omized to an oral contraceptive containing 35 mg ethinyl-estradiol plus 2 mg cyproterone acetate ( Diane(35 ) Diario ) or metformin ( 850 mg twice daily ) for 24 weeks . RESULTS There were no statistically significant differences in uric acid levels between PCOS and non-hyper and rogenic control women . Considering all PCOS and non-hyper and rogenic control women as a whole , obese women showed higher uric acid concentrations than lean and overweight women , and the main determinant of serum uric acid level was the BMI . In PCOS women , Diane(35 ) Diario treatment was related with a decrease in uric acid levels ( P = 0.018 ) , whereas no changes were observed with metformin . CONCLUSIONS Obesity is the main determinant of serum uric acid concentrations in PCOS patients , yet amelioration of and rogen excess with an anti and rogenic contraceptive pill results in a significant decrease in these levels , an effect that is not observed with metformin . Clinical Trials.gov NLM Identifier : NCT00428311 BACKGROUND Polycystic ovary syndrome ( PCOS ) is an endocrine disorder associated with metabolic dysfunction and changes in cardiovascular risk markers , and using oral contraceptives ( OCs ) may exert a further negative effect on these alterations in patients with PCOS . Thus , the primary objective of this study was to assess the effects on arterial function and structure of an OC containing chlormadinone acetate ( 2 mg ) and ethinylestradiol ( 30 mcg ) , alone or combined with spironolactone ( OC+SPL ) , in patients with PCOS . STUDY DESIGN This was a r and omized , controlled clinical trial . Fifty women with PCOS between 18 and 35 years of age were r and omized by a computer program to use OC or OC+SPL . Brachial artery flow-mediated vasodilation , carotid intima-media thickness and the carotid artery stiffness index were evaluated at baseline and after 6 and 12 months . Serum markers for cardiovascular disease were also analyzed . The intragroup data were analyzed using analysis of variance with Tukey 's post hoc test . A multivariate linear regression model was used to analyze the intergroup data . RESULTS At 12 months , the increase in mean total cholesterol levels was greater in the OC+SPL group than in the OC group ( 27 % vs. 13 % , respectively ; p=.02 ) . The increase in mean sex hormone-binding globulin levels was greater in the OC group than in the OC+SPL group ( 424 % vs. 364 % , respectively ; p=.01 ) . No statistically significant differences between the groups were found for any of the other variables . CONCLUSION The addition of spironolactone to an OC containing chlormadinone acetate and ethinylestradiol conferred no cardiovascular risk-marker advantages in young women with PCOS BACKGROUND A prospect i ve r and omized trial was conducted to compare the clinical efficacy of two oral contraceptives containing drospirenone in the treatment of hirsutism in women . STUDY DESIGN Fifty women with moderate to severe hirsutism were recruited . Three women were lost to follow-up . Twenty-four patients received oral 0.03 mg ethinyl estradiol and 3 mg drospirenone 21/7 regimen ( Group 1 ) for 6 months . Another group of 23 patients received oral 0.02 mg ethinyl estradiol and 3 mg drospirenone 24/4 regimen ( Group 2 ) for 6 months . Hirsutism was assessed after 6 months using the Ferriman-Gallwey ( F-G ) scoring system . Hormonal levels after 6 months of both therapies were compared with baseline values and each other . RESULTS An improvement in the F-G scores for hirsutism ( mean±SD ) was observed in Group 1 ( 17.3±5.2 to 8.7±2.5 , p<.001 ) and in Group 2 ( 17.5±4.8 to 7.9±2.8 , p<.001 ) . Pre- and post-treatment hirsutism scores were comparable between the groups ( p>.05 ) . Total and free testosterone levels decreased significantly after the therapy in both groups . The sex hormone-binding globulin levels increased significantly in both groups during the 6-month period . CONCLUSION The treatment of hirsutism with both combined oral contraceptives ( COCs ) containing drospirenone offered comparable effects and was well tolerated Introduction : Hirsutism is commonly a consequence of ovarian and rogen over-production . Polycystic ovary syndrome ( PCOS ) or peripheral hypersensitivity to normal and rogen circulating levels ( idiopathic hirsutism ) can be the underlying cause . Several drugs with anti- and rogenic properties , such as cyproterone acetate ( CPA ) , spironolactone and flutamide have been used to treat hirsutism , but the efficacy of these drugs has yet to be fully eluci date d. The objective of this study was to compare the effectiveness of flutamide , and spironolactone plus a combination tablet of 2 mg CPA/35 μg ethinyloestradiol ( EE ) in the treatment of hirsutism . Methods : A prospect i ve r and omised clinical study was conducted in a tertiary care hospital setting . Twenty-nine women with hirsutism as a consequence of PCOS or idiopathic hirsutism were r and omly assigned to receive 250 mg/day flutamide alone or 100 mg/day spironolactone plus a combination tablet of 2 mg CPA/35 μg EE , for 6 months . Patients ’ hormonal and lipid profiles were evaluated . Hirsutism was grade d according to the modified Ferriman-Gallwey ( mF-G ) score , and side effects were monitored . Results : A significant decrease in mF-G scores was observed in the flutamide ( from 11.2±3.3 to 7.6±4.0 ) and spironolactone plus CPA/EE ( from 9.9±1.9 to 7.1±2.0 ) groups . However , there was no statistically significant difference between the two groups . After flutamide therapy , total cholesterol levels decreased significantly but no significant change was observed in any other lipid parameters or in the patients ’ hormone profiles . After spironolactone plus CPA/EE  therapy , levels of luteinising hormone , total testosterone and free testosterone significantly decreased and triglyceride levels increased . No patients were found to have abnormal liver function test results . Conclusion : Flutamide and spironolactone plus CPA/EE are effective drugs in the treatment of hirsutism 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 To compare the short-term effects of metformin ( M ) , naltrexone ( N ) , and a combination of OC and prednisolone ( OC/Pr ) on the metabolic state and the ovarian function of PCOS women , we r and omized 29 women to a 3-month course of therapy . We observed significant improvements in hyper and rogenemia and ovulation rates in PCOS women of all three groups , in the absence of changes in the metabolic state , suggesting that insulin resistance in PCOS patients is only one of several factors leading to hyper and rogenemic ovarian failure Abstract Background : In clinical trials and non-interventional studies encompassing > 50 000 women , the monophasic , low-dose combined oral contraceptive ( OC ) chlormadinone acetate 2 mg/ethinylestradiol 0.03 mg ( CMA/EE ) has been shown to have various non-contraceptive benefits , as well as contraceptive efficacy and good tolerability . However , there is a paucity of data on use of this OC in young women . Objective : To investigate the relevance of , and changes in , cycle disorders , dysmenorrhoea and skin problems in addition to the efficacy and tolerability of CMA/EE in young women . Methods : In this prospect i ve , observational , non-interventional , multicentre study ( TeeNIS [ Teenager in Non-Interventional Study 2 mg CMA/0.03mgEE ] ) , young women ( ≤20 years of age ) were administered CMA/EE ( Belara ® ) once daily for 21 days ( one blister strip ) , followed by either a 7-day pill-free interval ( conventional cycle regimen ; 89.3 % ) or a pill-free interval after two blister strips or more ( extended cycle regimen ; 3.7 % ) , over a 6-month treatment period . Data on the mode of administration were missing for 7.1 % of patients . The study included a safety population of 7462 patients ( the efficacy population consisted of 6885 patients ) from 886 gynaecological centres throughout Germany . Results : Compared with baseline , CMA/EE intake result ed in significant reductions in the numbers of patients with cycle disorders , i.e. spotting ( −46 % ) , breakthrough bleeding ( −64 % ) , heavy bleeding ( −95 % ) and absence of any bleeding ( secondary amenorrhoea ; −76 % ) [ all p≤ 0.001 ] , and with dysmenorrhoea ( −56 % ) [ p≤ 0.001 ] . Similarly , there was a significant decrease in the number of patients who used analgesics ( −75 % ) , had dysmenorrhoea-associated symptoms ( back pain [ −69 % ] , headache [ −70 % ] , nausea/vomiting [ −85 % ] , diarrhoea [ −80 % ] , mood swings [ −75 % ] or absence from school/job due to dysmenorrhoea [ −92 % ] ) , or were restricted in their leisure/sporting activities because of dysmenorrhoea ( −83 % ) [ all p ≤ 0.001 ] . Another major benefit of CMA/EE was a significant reduction in the number of patients with skin problems ( acne and acne-prone skin ) [ −55 % ; p≤ 0.001 ] . In parallel , the number of patients who needed dermatological treatment  ( −67 % ; p≤ 0.001 ) and  concealer cosmetics  ( −55 % ; p≤ 0.001 ) was significantly reduced , and significantly fewer patients felt that their self-esteem was restricted due to skin problems ( −67 % ; p≤ 0.001 ) . There were no relevant weight changes during the observation period ; mean bodyweight remained virtually constant ( mean weight change < 1 kg ) . At final assessment , physicians ’ expectations were either ‘ completely fulfilled ’ or ‘ exceeded ’ with regard to cycle stability , regular bleeding , dysmenorrhoea , effects on weight , and skin problems in 78–95 % of patients . CMA/EE  provided high contraceptive efficacy with an unadjusted Pearl index of 0.25 , calculated from 41 601 cycles of exposure ; seven out of eight pregnancies were attributable to user failure , thus result ing in an adjusted Pearl index of 0.03 . The tolerability  of CMA/EE was excellent , with no unexpected adverse effects . Conclusions : This observational , non-interventional study in young women showed that CMA/EE had a significantly beneficial effect on cycle disorders , dysmenorrhoea and skin disorders , and confirmed the good efficacy and tolerability of this combined OC OBJECTIVE To study the blood clotting tests and endothelial function of polycystic ovary syndrome ( PCOS ) patients and non-hyper and rogenic women , and their changes during PCOS treatment , as a function of the presence of obesity and smoking . DESIGN Case-control study followed by a r and omized clinical trial . METHODS Blood clotting and endothelial function were analyzed in 40 PCOS patients and 20 non-hyper and rogenic women . Thirty-four PCOS women were r and omized to an oral contraceptive containing 35 microg ethinyl-estradiol plus 2 mg cyproterone acetate ( Diane(35)Diario ) or metformin ( 850 mg twice daily ) , monitoring the changes on these parameters during 24 weeks of treatment . The influence of obesity and smoking was also analyzed . RESULTS Blood clotting and endothelial function tests were similar among PCOS patients and controls with the exception of a higher platelet count in the former . Obesity increased circulating fibrinogen levels , prothrombin activity and platelet counts , and reduced prothrombin and activated partial thromboplastin times . Smoking increased fibrinogen levels , platelet counts , and prothrombin activity , and reduced prothrombin time , in relation to the larger waist circumference of smokers . Irrespective of the treatment received , PCOS patients showed a decrease in prothrombin time and an increase in prothrombin activity , with a parallel increase in homocysteine levels in metformin users . The activated partial thromboplastin time decreased markedly in the patients treated with Diane(35)Diario . Finally , flow-mediated dilation improved in non-smokers irrespective of the drug received , but worsened in smokers . CONCLUSIONS Oral contraceptives and metformin may exert deleterious effects on blood clotting tests of PCOS women , yet the effects of metformin appear to be milder . Because smoking potentiates some of these effects and deteriorates endothelial function , smoking cessation should be promoted in PCOS patients OBJECTIVE To test the hypothesis that the risk of adverse obstetric or neonatal outcomes varies according to different phenotypes of polycystic ovary syndrome ( PCOS ) , and to evaluate the clinical impact of the main features of PCOS . DESIGN Prospect i ve controlled clinical study . SETTING Academic Departments of Obstetrics and Gynecology , and of Endocrinology , Italy . PATIENT(S ) Ninety-seven pregnant women with PCOS and 73 healthy pregnant subjects were recruited as cases and controls , respectively . INTERVENTION(S )  Clinical , biochemical , and ultrasonographic evaluations .  MAIN OUTCOME MEASURE(S ) Obstetric and neonatal outcomes . RESULT ( S ) The relative risk ( RR ) for adverse obstetric or neonatal outcomes was increased ( 1.7 , 95 % confidence interval [ CI ] 1.12 - 2.96 ) in patients with PCOS and varied according to the PCOS phenotype ( 1.93 , 95 % CI 1.12 - 2.96 ; 2.23 , 95 % CI 1.21 - 3.15 ; 0.54 , 95 % CI 0.09 - 1.63 , and 0.48 , 95 % CI 0.31 - 0.78 for full-blown , nonpolycystic ovaries [ PCO ] , nonhyper and rogenic , and ovulatory phenotypes , respectively ) . The RRs were 1.57 ( 95 % CI 0.85 - 2.52 ) and 0.48 ( 95 % CI 0.31 - 0.78 ) for oligoanovulatory and ovulatory patients with PCOS , respectively . The risk for adverse obstetric or neonatal outcomes was affected significantly by ovarian dysfunction and biochemical hyper and rogenism , whereas no significant effect was detected for clinical hyper and rogenism and PCO . CONCLUSION ( S ) The increased risk for adverse obstetric and neonatal outcomes that was observed in patients with PCOS varies widely according to the different phenotypes and features of PCOS 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 BACKGROUND This study was conducted to investigate the effects of an oral contraceptive containing 30 mcg ethinyl estradiol and 2 mg dienogest on thyroid hormones and and rogen parameters . STUDY DESIGN Thyroid and and rogen parameters were measured in 59 women treated with a monophasic combined oral contraceptive containing 30 mcg ethinyl estradiol and 2 mg dienogest ( EE/DNG ) either conventionally ( 13 cycles with 21 days of treatment+7 days without hormones ) or according to an extended-cycle regimen ( four extended cycles with 84 days of continuous administration of  EE/DNG  , followed by a hormone-free interval of 7 days ) .  Blood sample s were taken on Days 21 - 26 of the preceding control cycle and on Days 19 - 21 of the 3rd and 13th conventional cycle , or on Days 82 - 84 of the first and fourth extended cycle . RESULTS At both time points , the serum concentrations of thyroxine-binding globulin were elevated by about 65 % in both treatment regimens . Likewise , both groups showed an increase in total triiodothyronine ( T3 ) and total thyroxine ( T4 ) by 30 - 40 % , and no change in free T4 . Until the 12th month of conventional treatment , the level of free T3 remained unchanged but decreased slightly during the extended-cycle regimen . In both groups there was a rise of sex hormone-binding globulin by 210 - 230 % after 3 months and by 220 - 250 % after 12 months . The levels of total testosterone were reduced by about 40 % and those of free testosterone by 55 - 65 % after 3 and 12 months . CONCLUSION The results suggest that , during conventional and extended-cycle treatment with EE/DNG , a steady state in the effects on thyroid hormones and and rogen parameters was reached within 3 months and that the changes in the various hormonal parameters did not substantially differ between conventional and extended-cycle regimen
INTRODUCTION This paper provides a critical review of the data concerning the effects of combined hormonal contraceptives ( CHC ) for polycystic ovary syndrome ( PCOS ) .
The aim is to determine the best treatment option for each PCOS phenotype .
Hyper and rogenism ( HA ) is the essential diagnostic criterion for PCOS and is frequently associated with insulin resistance ( IR ) or obesity .