17β-Estradiol: oral or parenteral administration in hyperandrogenic women? Metabolic tolerance in association with cyproterone acetate

Vexiau, P.; Fiet, Jean; Conard, J.; Abramovici, Y; Boudou, Philippe; Hardy, Noah; Consoli, Silla M.; Cathelineau, G

doi:10.1016/s0015-0282(16)57418-4

Cited by 19 publications

(3 citation statements)

References 18 publications

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“…Search results are shown in Figure . We included 157 studies comprising 10 550 women . The mean age varied between 15 years and 46 years, and the overall mean was 25·4 years.…”

Section: Resultsmentioning

confidence: 99%

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Interventions for hirsutism excluding laser and photoepilation therapy alone: abridged Cochrane systematic review includingGRADEassessments

Zuuren

Fedorowicz

2016

Br J Dermatol

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Hirsutism is a common disorder with a major impact on quality of life. The most frequent cause is polycystic ovary syndrome. Effects of interventions (except laser and light-based therapies) were evaluated, including Grading of Recommendations Assessment, Development and Evaluation assessments. Searches included Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, Medline, Embase and five trials registers to June 2014. We included 157 randomized controlled trials (RCTs) with 10 550 participants. The majority were assessed as having a 'high risk' of bias (123 of 157). The quality of evidence was rated moderate to very low for most outcomes. Pooled data for an oral contraceptive (OCP) (ethinyl oestradiol and cyproterone acetate) compared with another OCP (ethinyl oestradiol and desogestrel) demonstrated that both treatments were effective in reducing Ferriman-Gallwey scores, but the mean difference (MD) was not statistically significant [-1·84, 95% confidence interval (CI): -3·86-0·18]. Flutamide was more effective than placebo in two studies (MD -7·60, 95% CI: -10·53 to -4·67 and MD -7·20, 95% CI: -10·15 to -4·25), as was spironolactone (MD -7·69, 95% CI: -10·12 to -5·26). Spironolactone appeared to be as effective as flutamide (two studies) and finasteride (two studies). However, finasteride and the gonadotropin-releasing analogues showed discrepant results in several RCTs. Metformin was ineffective. Cyproterone acetate combined with OCPs demonstrated greater reductions in Ferriman-Gallwey scores. Lifestyle interventions reduced body mass index but did not show improvement in hirsutism, and although cosmetic measures are frequently used, no RCTs investigating cosmetic treatments were identified. RCTs investigating OCPs in combination with antiandrogens or finasteride vs. OCP alone, or the different antiandrogens and 5α-reductase inhibitors are warranted.

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“…Search results are shown in Figure . We included 157 studies comprising 10 550 women . The mean age varied between 15 years and 46 years, and the overall mean was 25·4 years.…”

Section: Resultsmentioning

confidence: 99%

“…and Table S1; see Supporting Information). One‐third of the studies (48 of 157) reported data that could not be further analysed (Table S2; see Supporting Information) . The remaining 109 studies covered 133 comparisons (Table S3; see Supporting Information) .…”

Section: Resultsmentioning

confidence: 99%

Interventions for hirsutism excluding laser and photoepilation therapy alone: abridged Cochrane systematic review includingGRADEassessments

Zuuren

Fedorowicz

2016

Br J Dermatol

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“…To the best of the authors' knowledge, this method of application of oestrogens has not previously been studied in PCOS, with the exception of one study (17) in which fasting insulin concentrations were lower after the oral administration of 17b-oestradiol than after the transdermal application of natural oestrogens.…”

Section: Introductionmentioning

confidence: 99%

Metabolic and endocrine effects of treatment with peroral or transdermal oestrogens in conjunction with peroral cyproterone acetate in women with polycystic ovary syndrome

Vrbíková

Stanická²,

Dvořáková³

et al. 2004

European Journal of Endocrinology

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Objective: To compare the influence of transdermal and peroral oestrogen treatments in conjunction with cyproterone acetate (CPA) on metabolic and hormonal parameters in women with polycystic ovary syndrome (PCOS). Patients and methods: Twenty-four women with PCOS, aged 25.4^4.3 (mean^S.D.) years, body mass index 24.5^3.9 kg/m 2 were randomly assigned to receive either transdermal oestradiol plus CPA (n ¼ 12) or a peroral oestradiol -CPA combination (n ¼ 12). Before and after 3 months of treatment, basal blood samples, euglycaemic hyperinsulinaemic clamp combined with indirect calorimetry and arginine tests were performed. ANOVA and Student's t-test or Wilcoxon's test were used for statistical analyses. Results: After peroral oestradiol -CPA, insulin sensitivity (P , 0.004) and the disposition index as the function of insulin sensitivity and secretion (P , 0.0001) decreased significantly. Fasting insulin (P , 0.05), cholesterol (P , 0.05), high-density lipoprotein cholesterol (P , 0.05) and sex-hormone binding globulin (P , 0.0001) increased significantly. Dehydroepiandrosterone (P , 0.05) and 17-OH progesterone (P , 0.01) decreased significantly. After transdermal oestradiol þ CPA, no significant changes were observed in sex-hormone binding globulin and androgen concentrations, insulin sensitivity or disposition index. Conclusions: In women with PCOS, peroral oestrogens (at doses common in combined oral contraceptives) led to a significant impairment in insulin secretion and action. In contrast, the transdermal application of oestrogens did not significantly influence insulin sensitivity. 150 215-223 European Journal of Endocrinology

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Cyproterone acetate for hirsutism

Spuy

Roux²,

Matjila

2003

Cochrane Database of Systematic Reviews

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17β-Estradiol: oral or parenteral administration in hyperandrogenic women? Metabolic tolerance in association with cyproterone acetate

Cited by 19 publications

References 18 publications

Interventions for hirsutism excluding laser and photoepilation therapy alone: abridged Cochrane systematic review includingGRADEassessments

Interventions for hirsutism excluding laser and photoepilation therapy alone: abridged Cochrane systematic review includingGRADEassessments

Metabolic and endocrine effects of treatment with peroral or transdermal oestrogens in conjunction with peroral cyproterone acetate in women with polycystic ovary syndrome

Cyproterone acetate for hirsutism

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