Evaluation of different antiandrogenic progestins on clinical and biochemical variables in polycystic ovary syndrome

Giuseppe Morgante, Valentina Cappelli, Libera Troìa, Vincenzo De Leo
The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception · 2020 · vol. 25(3) , pp. 176–181 · doi:10.1080/13625187.2020.1736546 · PMID:32191532 · W3012491756
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Dienogest and drospirenone significantly increased SHBG, dehydroepiandrosterone sulfate, and total testosterone levels in PCOS patients, with dienogest having a stronger effect than cyproterone acetate.

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Abstract

Objectives: The aim of the study was to update the results of a previous study published 10 years ago and compare the effect on hyperandrogenism of a newer progestin, dienogest (DNG), in a combined oral contraceptive (COC) formulation with ethinylestradiol (EE), with that of COCs containing the same dose of EE in combination with drospirenone (DRSP) and chlormadinone acetate (CMA).Methods: Sixty women with polycystic ovary syndrome (PCOS) aged between 16 and 35 and requiring antiandrogenic contraceptive treatment were randomised to one of three treatment groups: EE 30 µg/DRSP 3 mg, EE 30 µg/CMA 2 mg, EE 30 µg/DNG 2 mg. We evaluated the effects of the three COCs on sex hormone-binding globulin (SHBG) and biochemical markers of hyperandrogenism.Results: After 3 months of treatment, serum androgen concentrations were significantly improved in all treatment groups. Serum concentrations of SHBG were significantly increased with all COC treatments (p < 0.0001). Interestingly, DRSP had a greater effect (+218%; p < 0.0001) on serum SHBG concentrations compared with DNG and CMA (p < 0.04 and p < 0.002, respectively). Serum concentrations of total testosterone significantly decreased in all groups (p < 0.0001). DRSP had a significantly greater effect on total testosterone concentrations compared with DNG (p = 0.002) and CMA (p < 0.0001).Conclusion: Our study showed that DNG exerted an important stimulatory effect on SHBG concentrations, which was less than that of DRSP but greater than that of CMA. Similar results were also obtained for dehydroepiandrosterone sulphate and total testosterone.

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MeSH descriptors

Androgen Antagonists Contraceptives, Oral, Combined Polycystic Ovary Syndrome Progestins Sex Hormone-Binding Globulin Adolescent Adult Androgen Antagonists Androgens Androgens Androstenes Androstenes Biomarkers Biomarkers Chlormadinone Acetate Chlormadinone Acetate Contraceptives, Oral, Combined Ethinyl Estradiol Ethinyl Estradiol Female

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