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Oral contraceptive plus spironolactone safely addresses androgen excess in PCOS
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Women with polycystic ovary syndrome treated with a combination oral contraceptive with spironolactone were not at increased risk for metabolic or cardiovascular complications, according to findings published in the European Journal of Endocrinology.
Héctor F. Escobar-Morreale, MD, PhD, of the department of endocrinology and nutrition at Hospital Universitario Ramón y Cajal in Madrid, and colleagues evaluated 46 women with PCOS randomly assigned to metformin (n = 22) or to a combined oral contraceptive (ethinyl estradiol 30 µg and desogestrel 150 µg) plus 100 mg per day of the antiandrogen spironolactone (n = 24) for 1 year to determine efficacy and safety in relation to cardiometabolic risk factors and adverse events.
The primary composite outcome included efficacy and cardiometabolic safety; secondary outcomes included changes in anthropometric variables, office blood pressure, lipid profiles and indexes of glucose tolerance and insulin resistance.
In the contraceptive plus spironolactone group, hirsutism score decreased by 68%, and serum concentrations of total testosterone decreased by 54%, free testosterone by 79%, androstenedione by 46% and dehydroepiandrosterone sulfate by 26% compared with baseline. None of the measures decreased from baseline in the metformin groups, and DHEA sulfate levels increased by 35%.
Participants assigned to metformin continued to experience menstrual dysfunction, whereas the combined oral contraceptive group had regular menses.
BMI, weight and fasting glucose levels decreased in both groups, whereas no changes or differences were observed for fasting insulin concentrations or insulin sensitivity index. The contraceptive plus spironolactone group had increased serum HDL cholesterol and triglycerides compared with the metformin group, whereas there were no changes or differences between the groups for serum total and LDL cholesterol concentrations.
“According to our present results, oral contraceptives plus spironolactone is a much more effective treatment than metformin, showing excellent tolerability and safety, with no increased risk of metabolic dysfunction or cardiovascular risk factors,” Escobar-Morreale said in a press release. “An evidence-based update to the PCOS treatment guidelines could lead to enhanced quality of life and improved long-term outcomes for patients.” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.
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