Article

Influence of oral contraceptives on anthropomorphometric, endocrine, and metabolic profiles of anovulatory polycystic ovary syndrome patients

Fertility and sterility (Impact Factor: 4.59). 06/2014; 101(6). DOI: 10.1016/j.fertnstert.2014.02.039

ABSTRACT

Objective
To evaluate the influence of oral contraceptive pills (OCPs) on anthromorphometric, endocrine, and metabolic parameters in women with polycystic ovary syndrome (PCOS).

Design
Retrospective cross-sectional cohort study for the period 1993–2011.

Setting
Tertiary university hospital.

Patient(s)
PCOS patients, who never, ever, or at time of screening were using OCPs were included. A total of 1,297 patients, of whom 827 were white, were included. All PCOS patients diagnosed according to the Rotterdam 2003 consensus criteria were divided into three groups: current users, (n = 76; 6% of total), ever users (n = 1,018; 78%), and never users (n = 203; 16%). Ever users were subdivided based on the OCP-free interval.

Intervention(s)
None.

Main Outcome Measure(s)
Anthromorphometric (blood pressure, cycle duration) and ultrasound (follicle count, mean ovarian volume) parameters, endocrine (SHBG, testosterone, free androgen index, antimüllerian hormone [AMH]) and lipid profiles.

Result(s)
Current users and ever users were compared with never users. In current users, SHBG was increased and androgen levels decreased. Patients with an OCP-free interval of <1 year had a higher mean follicle count, higher AMH level, and increased serum androgen level compared with never users. SHBG levels remained increased until 5–10 years after cessation of OCP use.

Conclusion(s)
OCP use causes a milder phenotypic presentation of PCOS regarding hyperandrogenism. However, it does not alter parameters associated with increased health risks.

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Available from: Bart C J M Fauser, Oct 11, 2015
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    • "As explained above, there is, however, controversy regarding the impact of hormonal contraception on the AMH circulating level[6,38]. In PCOS, it has recently been shown[94]that in current users of hormonal contraception, SHBG was increased, leading to a diminished bioavailable androgen level, and that AMH and AFC levels were decreased. However, no study has reported so far this decrease of serum AMH has a predictive value on the subsequent fertility. "
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    ABSTRACT: Polycystic ovary syndrome (PCOS) is the most common cause of chronic anovulation and hyperandrogenism in young women. Excessive ovarian production of Anti-Müllerian Hormone, secreted by growing follicles in excess, is now considered as an important feature of PCOS. The aim of this review is first to update the current knowledge about the role of AMH in the pathophysiology of PCOS. Then, this review will discuss the improvement that serum AMH assay brings in the diagnosis of PCOS. Last, this review will explain the utility of serum AMH assay in the management of infertility in women with PCOS and its utility as a marker of treatment efficiency on PCOS symptoms. It must be emphasized however that the lack of an international standard for the serum AMH assay, mainly because of technical issues, makes it difficult to define consensual thresholds, and thus impairs the widespread use of this new ovarian marker. Hopefully, this should soon improve.
    Full-text · Article · Dec 2015 · Reproductive Biology and Endocrinology
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    • "Another attractive aspect of serum AMH measurements is that they are not affected by contraceptive medications to the same degree as serum FSH, which propagated the unfortunate misunderstanding that AMH was not affected by contraceptives. Numerous studies have now confirmed that hormonal contraceptives often lower serum AMH [93–96]. A well designed prospective study of 44 women demonstrated serum AMH was lowered by an average of approximately 30% within two menstrual cycles of starting the contraceptive regardless of the route [97▪▪]. "
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    ABSTRACT: Purpose of review To provide an update on the latest clinical applications of serum antimüllerian hormone (AMH) testing with practical approaches to mitigate the impact of significant variability in AMH results. Recent findings Recent studies continue to demonstrate that AMH is the best single serum test for ovarian response management with, at most, a weak-to-moderate age-independent association with live-birth rate and time to conception. Data confirm serum AMH levels improve menopause prediction, monitoring of ovarian damage, and identification of women at risk for several ovary-related disorders such as polycystic ovary syndrome and premature or primary ovarian insufficiency. However, it is now recognized that serum AMH results can have dramatic variability due to common, biologic fluctuations within some individuals, use of hormonal contraceptives or other medications, certain surgical procedures, specimen treatment, assay changes, and laboratory calibration differences. Practical guidelines are provided to minimize the impact of variability in AMH results and maximize the accuracy of clinical decision-making. Summary AMH is an ovarian biomarker of central importance which improves the clinical management of women's health. However, with the simultaneous rapid expansion of AMH clinical applications and recognition of variability in AMH results, consensus regarding the clinical cutpoints is increasingly difficult. Therefore, a careful approach to AMH measurement and interpretation in clinical care is essential.
    Full-text · Article · Jun 2014 · Current Opinion in Obstetrics and Gynecology
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    ABSTRACT: AimTo compare the effects of ethinyl estradiol (EE) 30 mcg/desogestrel 150 mcg plus spironolactone 25 mg/day (group A) versus EE 35 mcg/cyproterone acetate 2 mg (group B) on hyperandrogenism and metabolism in PCOS.Methods This was a randomized clinical study. Eighteen women in groups A and B received medications for three cycles. Acne score, androgens and metabolic parameters were assessed before and after treatment.ResultsOne and two women in groups A and B, respectively, were excluded from the study. Both groups had significantly decreased acne score and free androgen index, and increased sex hormone-binding globulin levels. Cholesterol and high-density lipoprotein were significantly increased in group B, and androstenedione was significantly decreased in group A. The regular withdrawal bleeding was obtained in both groups.Conclusion Both regimens had quite similar efficacy on hyperandrogenism after three cycles of therapy and without any changes in metabolic parameters.
    No preview · Article · Nov 2014 · Journal of Obstetrics and Gynaecology Research
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