July 21st, 2018

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Body Mass Index Does Not Affect Suppression of Hyperandrogenism but Does Impact Carbohydrate Metabolism During Low-Dose Folate-Supplemented Ethinyl Estradiol/Drospirenone Oral Contraceptive Therapy in Women with Polycystic Ovary Syndrome
Authors:  Karen E. Elkind-Hirsch, M.Sc., Ph.D., Martha Paterson, M.D., Ericka Seidemann, M.S., and Hanh Gutowski, R.N.
  OBJECTIVE: To evaluate low-dose folate-supplemented ethinyl estradiol–drospirenone (EE/DRSP) oral contraceptive (OC) therapy on clinical, hormonal, and cardiometabolic parameters in women with polycystic ovary syndrome (PCOS) stratified by body mass index (BMI).

STUDY DESIGN: Women (aged 16–35 yrs; n=64) with PCOS were enrolled. BMI, androgens (DHEAS, T, SHBG, free androgen index [FAI]), lipids, folate, glucose, and insulin levels during an oral glucose tolerance test were measured before and after 24 weeks on the OC regimen. Factorial repeated measure ANOVAs were used to make comparisons between the BMI groups and treatment intervals.

RESULTS: In 53 subjects (14 normal, 18 overweight, and 21 obese) who completed the study, BMI had no impact on OC efficacy in normalizing cycle frequency, decreasing androgens and FAI, and increasing SHBG and folate levels (p<0.001). In obese PCOS subjects, insulin sensitivity and β-cell function were negatively affected by EE/DRSP. The oral disposition index significantly decreased in obese users in contrast to nonobese PCOS women.

CONCLUSION: OC therapy was effective in reducing hyperandrogenism independent of BMI. The differences in response to EE/DRSP treatment between obese and nonobese PCOS patients suggest that obesity has a significant role inthe metabolic impact of contraceptive therapy (ClinicalTrials.gov Identifier: NCT03160996).
Keywords:  body mass index; folate; hyperandrogenism; oral contraceptives; oral contraceptives, low-dose; polycystic ovary syndrome
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