Mastorakos, G., Koliopoulos, C., & Creatsas, G. (2002). Androgen and lipid profiles in adolescents with polycystic ovary syndrome who were treated with two forms of combined oral contraceptives. Fertility and Sterility, 77(5), 919-927. https://doi.org/10.1016/s0015-0282(02)02993-x
Mastorakos G, Koliopoulos C, Creatsas G. Androgen and lipid profiles in adolescents with polycystic ovary syndrome who were treated with two forms of combined oral contraceptives. Fertil Steril. 2002;77(5):919-927. doi:10.1016/s0015-0282(02)02993-x
Mastorakos, George, et al. "Androgen and lipid profiles in adolescents with polycystic ovary syndrome who were treated with two forms of combined oral contraceptives." Fertility and Sterility, vol. 77, no. 5, 2002, pp. 919-927.
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RRM Academy Synopsis
Two combined pills lowered hirsutism and androgens in teens with PCOS
A randomized trial of 28 girls aged 14 to 19 with polycystic ovary syndrome (PCOS) found that both birth control pills lowered excess hair growth and androgen levels in 12 months. Total, LDL and HDL cholesterol rose in both groups while the ratios stayed level. Triglycerides rose over time only in the cyproterone acetate group.
Key Findings
Twenty-eight girls aged 14 to 19 were randomly assigned, 14 per group, to a desogestrel pill or a cyproterone acetate pill, each combined with ethinyl estradiol, for 12 months.
The Ferriman-Gallway hirsutism score fell significantly from the sixth month in both groups. The groups' scores did not differ significantly at any time point.
Testosterone, free testosterone, androstenedione and 17OH-progesterone fell significantly in both groups, and sex hormone-binding globulin rose. The hormone levels did not differ between groups.
Total cholesterol, LDL cholesterol and HDL cholesterol all rose significantly in both groups. The ratios of total and of LDL cholesterol to HDL cholesterol stayed level.
Triglycerides rose significantly from the third month in the cyproterone acetate group only, with a tendency toward a difference between groups at 12 months.
Interpretation
The authors ran a prospective randomized trial with 14 girls per group over 12 months. Investigators who scored hair growth were blinded to treatment. The girls were 14 to 19 years old and met the 1990 NIH criteria for PCOS. The girls received no advice to lose weight, and BMI stayed level. The authors suggest that both pills seem suitable for long-term treatment of young patients with PCOS.
RRM Context
Birth control pills are suppressive medications, so these changes occurred during treatment. Restorative reproductive medicine asks what drives high androgens and irregular cycles in teens with PCOS. PCOS is also called PMOS (Polyendocrine Metabolic Ovarian Syndrome). At baseline, a higher BMI went with higher free testosterone and higher cholesterol ratios. The authors advise weight loss, exercise and psychological support for obese teens.
Our editorial summary of this paper, not the article's abstract.
Abstract
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
Prospective randomized clinical trial.
Setting
Outpatient gynecology clinic (referral center) of a university.
Patients
Twenty-eight adolescent girls with clinical and biological hyperandrogenism and six or less menses during the past 12 months.
Interventions
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 Measures
Hirsutism and lipid profile were evaluated before initiation and at 3, 6, 9, and 12 months of treatment. Androgen profile was evaluated before and at 12 months of treatment.
Results
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)-androstenedione, 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.
Conclusions
Treatment of adolescent girls with PCOS with the two studied formulations is comparably effective in decreasing hirsutism and androgen 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.
