Human Reproduction, Vol 12, 423-429, Copyright © 1997 by Oxford University Press
P Acien, M Mauri and M Gutierrez
The aim of this study was to compare the clinical and hormonal effects of
the combination of a long-acting gonadotrophin-releasing hormone analogue
(GnRH-a) plus an oral contraceptive (OC) pill containing ethinyl-oestradiol
(EE) and cyproterone acetate (CPA) versus the EE-CPA pill alone in patients
with polycystic ovarian disease (PCOD) and related hyperandrogenisms, in
order to evaluate whether the addition of GnRH-a has any advantage. A total
of 12 PCOD patients were treated with the EE-CPA pill alone for 10
consecutive cycles according to an OC standard regimen. A further 12
patients were treated with GnRH-a, one i.m. injection every 28 days for a
total of eight injections, combined with the EE-CPA pill for 10 consecutive
cycles. The latter was thus prolonged for two cycles more than GnRH-a.
Clinical evaluations (symptoms, weight, Ferriman-Gallwey score) and
hormonal and biochemical analyses were assessed before, during (at 3 or 6
months) and after treatment, either when spontaneous cycles had resumed or
after 3 months of amenorrhoea. There was a significant improvement in
hirsutism, and a strong reduction in gonadotrophin, oestradiol,
testosterone, androstenedione and 17-OH-progesterone concentrations in both
treatment groups but with no significant differences between them, except
in the gonadotrophin concentrations. Cortisol and triglyceride
concentrations increased during treatment in both groups. The
Ferriman-Gallwey score remained significantly decreased in both groups
after treatment, as did androstenedione in the GnRH-a plus EE-CPA pill
group, but there were no significant differences between the two groups. No
changes were observed in prolactin, dehydroepiandrosterone sulphate
(DHEA-S), insulin, glycaemia and cholesterol concentrations. However, when
only the obese and more hirsute patients were considered, significant
differences between the two groups were found during treatment in the
Ferriman-Gallwey score and the gonadotrophin and DHEA-S concentrations
(which increased during treatment in obese patients with the pill alone),
and after treatment in the Ferriman-Gallwey score and the concentration of
17-OH-progesterone in the more hirsute patients, with the GnRH-a plus pill
group having better results. In conclusion, a cyclic prolonged treatment
with OC EE-CPA pills is not improved in most PCOD patients by the addition
of GnRH-a, and is complicated and expensive. However, the addition of a
long-acting GnRH-a may be recommended in obese and severely hirsute
patients.
ARTICLES
Clinical and hormonal effects of the combination gonadotrophin- releasing hormone agonist plus oral contraceptive pills containing ethinyl-oestradiol (EE) and cyproterone acetate (CPA) versus the EE-CPA pill alone on polycystic ovarian disease-related hyperandrogenisms
Department of Gynecology, San Juan University Hospital and School of Medicine, Spain.
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