A differential approach to the administration of combined oral contraceptives in polycystic ovary syndrome


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Abstract

Aim. To investigate the effect of combined oral contraceptives (COC) containing ethinyl estradiol/drospirenone (EE/DRSP) and estradiol valerate/dienogest (EV/DNG) on the endocrine and metabolic profiles of patients with polycystic ovary syndrome (PCOS). Materials and methods. One hundred patients with PCOS were randomized into two groups to receive either EV/ DNG (group I, n=50, 24.1±2.8 years) or EE/DRSP (group II, n=50, 25.6±2.1 years). All patients underwent clinical, laboratory, and diagnostic investigations at baseline and after 12 months of treatment. Results. Both EE/DRSP and EV/DNG were effective in improving clinical and biochemical HA. Mean levels of TT decreased by 17% and 20%, FT - by 19% and 29% in group I and II, respectively (p> 0.05). There was a 17% and 28% reduction in the levels of A in group I and II, respectively (p> 0.05). Mean levels of SHBG showed a 2.2 and 5.7 fold increase in group I and II, respectively (p <0.05). In the absence of a negative effect on most metabolic parameters, EV/DNG reduced the rates of impaired glucose tolerance (IGT) and hyperinsulinemia (HI) by 12% and 14%, respectively; EE/DRSP occasionally caused HI and IGT. There was an increase in mean TG levels by 16% and 29% in patients of group I and II, respectively (p <0.05). Conclusion. The study findings suggest the feasibility of a differential approach to the administration of COCs. In patients with metabolic disorders and thrombotic risk (in the absence of high-risk thrombophilia), the treatment of choice may be EV/DNG. In PCOS patients with signs of hyperandrogenism but without significant metabolic disorders, EE/DRSP should be preferred.

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About the authors

G. E Chernukha

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology of Minzdrav of Russia

Email: g_chernukha@oparina4.ru
MD, Professor, Head of the Department of Gynecologic Endocrinology.

G. I Tabeeva

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology of Minzdrav of Russia

Ph.D., Senior Researcher at the Department of Gynecologic Endocrinology

M. R Dumanovskaya

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology of Minzdrav of Russia

Ph.D., Researcher at the Department of Gynecologic Endocrinology

L. A . Marchenko

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology of Minzdrav of Russia

MD, Professor, Leading Researcher at the Department of Gynecologic Endocrinology

References

  1. Cascella T., Palomba S., De Sio I., Manguso F., Giallauria F., De Simone B. et al. Visceral fat is associated with cardiovascular risk in women with polycystic ovary syndrome. Hum. Reprod. 2008; 23(1): 153-9.
  2. Orio F., Vuolo L., Palomba S., Lombardi G., Colao A. Metabolic and cardiovascular consequences of polycystic ovary syndrome. Minerva Ginecol. 2008; 60(1): 39-51.
  3. Anwar S., Shikalgar N. Prevention of type 2 diabetes mellitus in polycystic ovary syndrome: A review. Diabetes Metab. Syndr. 2017; 11(Suppl. 2): S913-7.
  4. Halperin I.J., Kumar S.S., Stroup D.F., Laredo S.E. The association between the combined oral contraceptive pill and insulin resistance, dysglycemia and dyslipidemia in women with polycystic ovary syndrome: a systematic review and meta-analysis of observational studies. Hum. Reprod. 2011; 26(1): 191-201.
  5. Rotterdam ESHRE/ASRM-Sponsored PC OS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil. Steril. 2004; 81: 19-25.
  6. Teede H.J., Misso M.L., Costello M.F., Dokras A., Laven J., Moran L. et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum. Reprod. 2018; 33(9): 1602-18.
  7. Martin K.A., Chang R.J., Ehrmann D.A., Ibanez L., Lobo R.A., Rosenfield R.L. et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 2008; 93(4): 1105-20.
  8. Zimmerman Y., Eijkemans M.J., Coelingh Bennink H.J., Blankenstein M.A., Fauser B.C. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis. Hum. Reprod. Update. 2014; 20(1): 76-105.
  9. Bhattacharya S.M., Jha A. Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone in patients with polycystic ovary syndrome. Fertil. Steril. 2012; 98(4): 1053-9.
  10. Ehrmann D.A. Polycystic ovary syndrome. N. Engl. J. Med. 2005; 352(12): 1223-36.
  11. Lopez L.M., Grimes D.A., Schulz K.F. Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus. Cochrane Database Syst. Rev. 2014; (4): CD006133.
  12. Sitruk-Ware R., Nath A. Characteristics and metabolic effects of estrogen and progestins contained in oral contraceptive pills. Best Pract. Res. Clin. Endocrinol. Metab. 2013; 27(1): 13-24.
  13. Пшеничникова Т.Б., Пшеничникова Е.Б. Генетическая и приобретенная формы тромбофилии у больных с метаболическим синдромом в сочетании с синдромом поликистозных яичников. Акушерство и гинекология. 2006; 5: 29-31.
  14. Burchall G.F., Piva T.J., Linden M.D., Gibson-Helm M.E., Ranasinha S., Teede H.J. Comprehensive assessment of the hemostatic system in polycystic ovarian syndrome. Semin. Thromb. Hemost. 2016; 42(1): 55-62.
  15. Idali F., Zareii S., Mohammad-Zadeh A., Reihany-Sabet F., Akbarzadeh-Pasha Z., Khorram-Khorshid H.R. et al. Plasminogen activator inhibitor 1 and methylenetetrahydrofolate reductase gene mutations in iranian women with polycystic ovary syndrome. Am. J. Reprod. Immunol. 2012; 68(5): 400-7.
  16. Линников В.И., Бондаренко Н.И. Влияние оральных контрацептивов на систему гемостаза и метаболизм липидов. Таврический медикобиологический вестник. 2011; 14(3,1): 141-3.
  17. Хамани Н.М. Клиническое значение контроля гемостаза у женщин, принимающих гормональные контрацептивы: дисс. канд. мед. наук. М.; 2018.
  18. Макацария А.Д., ред. Тромбогеморрагические осложнения в акушерско-гинекологической практике. Руководство для врачей. М.: МИА; 2007: 17-76.
  19. Макацария А.Д., Саидова Р.А. Гормональная контрацепция и тромбофилические состояния. М.: Триада Х.; 2004.
  20. van Vliet H.A., Bertina R.M., Dahm A.E., Rosendaal F.R., Rosing J., Sandset P.M., Helmerhorst F.M. Different effects of oral contraceptives containing different progestogens on protein S. and tissue factor pathway inhibitor. J. Thromb. Haemost. 2008; 6(2): 346-51.
  21. Cravioto M.D. New recommendations from the World Health Organization (WHO) for the use of contraceptive methods. Gac. Med. Mex. 2016; 152(5): 601-3.
  22. Lizneva D., Gavrilov a-Jordan L., Walker W., Azziz R. Androgen excess: investigations and management. Best Pract. Res. Clin. Obstet. Gynaecol. 2016; 37: 98-118.
  23. Найду ко в а А. А., Каприна Е.К., Иванец Т.Ю., Чернуха Г.Е. Значение АМГ в диагностике синдрома поликистозных яичников. Акушерство и гинекология. 2017; 1: 46-52.
  24. Найдукова А.А., Каприна Е.К., Иванец Т.Ю., Чернуха Г.Е. Возрастные аспекты оценки уровня антимюллерова гормона при синдроме поликистозных яичников. Акушерство и гинекология. 2017; 3: 95-100.
  25. Чернуха Г.Е., Блинова И. В., Купрашвили М. И. Эндокриннометаболические характеристики больных с различными фенотипами синдрома поликистозных яичников. Акушерство и гинекология. 2011; 2: 70-6.
  26. Yildizhan R., Gokce A., Yildizhan B., Cim N. Comparison of the effects of chlormadinone acetate versus drospirenone containing oral contraceptives on metabolic and hormonal parameters in women with PCOS for a period of two-year follow-up. Gynecol. Endocrinol. 2015; 31(5): 396-400.
  27. Remde H., Hanslik G., Rayes N., Quinkler M. Glucose metabolism in primary aldosteronism. Horm. Metab. Res. 2015; 47(13): 987-93.
  28. Gallo M.F., Lopez L.M., Grimes D.A., Carayon F., Schulz K.F., Helmerhorst F.M. Combination contraceptives: effects on weight. Cochrane Database Syst. Rev. 2014; (1): CD003987.
  29. Amiri M., Ramezani Tehrani F., Nahidi F., Kabir A., Azizi F. Comparing the effects of combined oral contraceptives containing progestins with low androgenic and antiandrogenic activities on the hypothalamic-pituitary-gonadal axis in patients with polycystic ovary syndrome: systematic review and meta-analysis. JMIR Res. Protoc. 2018; 7(4): e113.
  30. Raps M., Helmerhorst F., Fleischer K., Thomassen S., Rosendaal F., Rosing J. et al. Sex hormone-binding globulin as a marker for the thrombotic risk of hormonal contraceptives. J. Thromb. Haemost. 2012; 10(6): 992-7.
  31. Raps M., Rosendaal F., Ballieux B., Rosing J., Thomassen S., Helmerhorst F., van Vliet H. Resistance to APC and SHBG levels during use of a four-phasic oral contraceptive containing dienogest and estradiol valerate: a randomized controlled trial. J. Thromb. Haemost. 2013; 11(5): 855-61.
  32. Dinger J., Minh T.D., Heinemann K. Impact of estrogen type on cardiovascular safety of combined oral contraceptives. Contraception. 2016; 94(4): 328-39.
  33. Григорян О.Р., Андреева Е.Н. Влияние эстрадиола валерата и диеногеста в составе КОК на систему гемостаза (обзор литературы). Проблемы репродукции. 2015; 21(2): 14-7.

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