Hum. Reprod. Advance Access originally published online on June 30, 2004
Human Reproduction 2004 19(8):1725-1727; doi:10.1093/humrep/deh329
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Flutamide–metformin plus an oral contraceptive (OC) for young women with polycystic ovary syndrome: switch from third- to fourth-generation OC reduces body adiposity
1 Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Spain and 2 Department of Pediatrics, University of Leuven, Belgium
3 To whom correspondence should be addressed at: Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain. Email: libanez{at}hsjdbcn.org
BACKGROUND: Low-dose flutamide–metformin has been developed as a background therapy for non-obese adolescents and young women with hyperinsulinaemic hyperandrogenism, a variant of polycystic ovary syndrome (PCOS). We verified whether the lipolytic efficacy of flutamide–metformin in women with PCOS is enhanced by giving an oral contraceptive (OC) co-therapy that contains drospirenone, instead of gestodene, as progestin. METHODS: An open-labelled study was carried out in which non-obese women with PCOS (n=29; age 
20 years), who had been on a combination of flutamide (62.5 mg/day), metformin (850 mg/day) and ethinylestradiol–gestodene for 8–15 months, were randomized for replacement of the gestodene OC by a drospirenone OC. Assessments of endocrine–metabolic state and body composition (by dual-energy X-ray absorptiometry) were performed at randomization and after 6 months. RESULTS: The switch to drospirenone OC was accompanied by a reduction of total and abdominal fat (mean –0.8 and –0.5 kg) and by an increment of lean body mass (+0.6 kg; all P<0.01), so that body adiposity was strikingly reduced without changing body weight. CONCLUSION: In non-obese women with PCOS, low-dose flutamide–metformin reduces total and abdominal fat excess more effectively if contraceptive co-therapy contains drospirenone, instead of gestodene, as progestin.
Key words: abdominal fat mass/drospirenone/flutamide/metformin/PCOS
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