Polycystic ovary syndrome and cardiovascular risk in young patients treated with drospirenone-ethinylestradiol or contraceptive vaginal ring. A prospective, randomized, pilot study

Battaglia, Cesare; Mancini, Fulvia; Fabbri, Raffaella; Persico, Nicola; Busacchi, Paolo; Facchinetti, Fabio; Venturoli, Stefano

doi:10.1016/j.fertnstert.2009.05.044

Cited by 50 publications

(58 citation statements)

References 33 publications

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“…Most of the studies included only a small number of participants with a limited follow-up period, and several confounding factors that might have influenced the results were not taken into account in these studies. Long-term risks and benefits of the use of other modalities remain largely unknown, including [1] contraceptives delivered by nonoral routes (i.e., transdermal or vaginal) (72,73), [2] OCPs combined with other treatment modalities such as antiandrogens or insulin sensitizers, and [3] progestin-only contraceptives.…”

Section: Discussionmentioning

confidence: 99%

Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group

Fauser

Tarlatzis

Rebar

et al. 2012

Fertility and Sterility

1,648

1,104

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Section: Discussionmentioning

confidence: 99%

Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group

Fauser

Tarlatzis

Rebar

et al. 2012

Fertility and Sterility

1,648

1,104

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“…In one study on 16 lean and 12 overweight PCOS subjects, after giving 30 mg ethinyl estradiol (E 2 ) and 3 mg DRSP for 6 months, no effects were found on endothelial function or CVR indices (71). In a second study, ethinyl E 2 /DRSP was associated with an increase in systolic, diastolic and 24-h blood pressure of about 5 mmHg and an increase in triglyceride levels (72). A third study using a lower dose of 20 mg ethinyl E 2 showed improved insulin sensitivity and did not adversely affect blood pressure or serum lipid values, effects that were not enhanced with the addition of metformin (73).…”

Section: Medical Intervention In Pcosmentioning

confidence: 98%

“…Drospirenone (DRSP) is a 17a-spironolactone derivative progestin that combines progestogenic activity with anti-androgenic and anti-mineralocorticoid activity that may therefore have a beneficial CVR profile (71,72,73). In one study on 16 lean and 12 overweight PCOS subjects, after giving 30 mg ethinyl estradiol (E 2 ) and 3 mg DRSP for 6 months, no effects were found on endothelial function or CVR indices (71).…”

Section: Medical Intervention In Pcosmentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Recent advances in cardiovascular aspects of polycystic ovary syndrome

Sathyapalan

Atkin²

2012

European Journal of Endocrinology

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Polycystic ovary syndrome (PCOS) has been associated with increased cardiovascular risk (CVR) markers, but population studies have not clarified whether there is an increase in cardiovascular morbidity and mortality. Four different PCOS phenotypes resulted from the Rotterdam criteria that may differ in their CVR potential, thus introducing further complexity. This has led to studies using surrogate CVR markers including biomarkers in blood and imaging such as flow-mediated vasodilatation. In PCOS, both peripheral and central insulin resistance (IR) have been shown. Weight loss has been shown to improve IR and visceral fat, while insulin sensitizer therapies with metformin or thiazolidinediones improve IR and endothelial dysfunction. IR is also found in non-alcoholic fatty liver disease that in turn is very common in PCOS; studies have suggested that IR may be improved by treatment with metformin and omega-3 fish oils. PCOS patients have a more dyslipidemic phenotype that is worse in 'classical PCOS' associated with a higher CVR. Studies with atorvastatin and simvastatin have reported a decrease in the lipid parameters and an improvement in CVR indices including IR, but it is unclear whether this is due to their lipid-lowering action or a pleiotropic effect of the statin. In this expert opinion review, the relevant literature published during the last 2 years was considered. It focuses on some recent important data that has emerged while also exposing the gaps that remain in our knowledge that need to be addressed.

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“…Metabolic changes overall, however, did not result in significant concentrations outside the normal ranges. In young women with PCOS (aged 20–25 years) treated with an OCP containing drospirenone versus a combined contraceptive vaginal ring, an RCT suggested that both methods worsened the lipid profile, but OCP significantly worsened triglycerides while remaining within the normal range [237]. In adult women, an RCT involving OCP with 3 different progestins (desogestrel, drospirenone, and cyproterone acetate) showed identical metabolic impact [238].…”

Section: Treatment Of Pcosmentioning

confidence: 99%

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

Ibáñez¹,

et al. 2017

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This paper represents an international collaboration of paediatric endocrine and other societies (listed in the Appendix) under the International Consortium of Paediatric Endocrinology (ICPE) aiming to improve worldwide care of adolescent girls with polycystic ovary syndrome (PCOS)¹. The manuscript examines pathophysiology and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Müllerian hormone, hyperinsulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne, and menstrual irregularities 2 years beyond menarche, and elevated androgen levels. Polycystic ovarian morphology on ultrasound without hyperandrogenism or menstrual irregularities should not be used to diagnose adolescent PCOS. Hyperinsulinemia, insulin resistance, and obesity may be present in adolescents with PCOS, but are not considered to be diagnostic criteria. Treatment of adolescent PCOS should include lifestyle intervention, local therapies, and medications. Insulin sensitizers like metformin and oral contraceptive pills provide short-term benefits on PCOS symptoms. There are limited data on anti-androgens and combined therapies showing additive/synergistic actions for adolescents. Reproductive aspects and transition should be taken into account when managing adolescents.

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Polycystic ovary syndrome and cardiovascular risk in young patients treated with drospirenone-ethinylestradiol or contraceptive vaginal ring. A prospective, randomized, pilot study

Cited by 50 publications

References 33 publications

Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group

Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group

MECHANISMS IN ENDOCRINOLOGY: Recent advances in cardiovascular aspects of polycystic ovary syndrome

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

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