Background: Polycystic ovary syndrome (PCOS) is characterized by anovulation, infertility, and hyperandrogenism. The present study aims to compare the clinical, biochemical, and hormonal changes in PCOS patients taking estradiol-cyproterone acetate (ECA), metformin (MET), and rosiglitazone (ROSI).
Methods: Ninety-four patients with PCOS were randomized according to the therapy they received as follows: MET 2 g/d group (n = 47), ROSI 4 mg/d group (n = 14), and 35 μg ethinyl estradiol–2 mg cyproterone acetate group (ECA) (n = 33). Complete hormonal assays, lipid profile, glucose, and insulin levels were studied over a 4-months period.
Results: Patients randomized to the MET group lost more weight and had a greater reduction in BMI compared with baseline (P = 0.006 and P = 0.004). The reduction in triglyceride levels and high-sensitivity C-reactive protein (hs-CRP) were statistically significant in the MET group while no changes were observed in the other groups. Regarding HDL levels, did not change in MET and ECA groups, but there was a significant increase compared with baseline in the ROSI group (P = 0.04). Mann-Whitney U test showed that the change (a tendency of reduction) was more significant in PCOS patients on MET for both total cholesterol and LDL-cholesterol (P < 0.001). The rate of improvement in oligomenorrhea was similar in all 3 treatments (P = 0.202).
Conclusion: Our data show that in women with PCOS, ECA is more effective than insulin-sensitizing drugs such as rosiglitazone and metformin in improving menstrual pattern and reducing serum free-testosterone levels. MET, an insulin-sensitizing drug, is more effective in reducing fasting insulin levels than the ECA.