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

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.

摘要

目的：这项研究的目的是更新10年前发表的先前研究的结果, 并比较新型孕激素地诺孕素（DNG）与炔雌醇（EE）联合口服避孕药（COC）制剂对雄激素过多的影响, 与含有相同剂量EE的COCs联合屈螺酮（DRSP）和醋酸氯地孕酮（CMA）的COCs。

方法：将60名年龄在16至35岁之间且需要抗雄激素避孕药治疗的多囊卵巢综合征（PCOS）女性随机分为三个治疗组之一：EE 30 mg/DRSP 3 mg, EE 30 mg/CMA 2 mg, EE 30 mg/DNG 2毫克。我们评估了三种COCs对性激素结合球蛋白（SHBG）和雄激素过多症生化标志物的影响。

结果：治疗3个月后, 在所有治疗组中血清雄激素浓度显著改善。所有COC治疗的血清SHBG浓度均显著增加（p<0.0001）。有趣的是, 与DNG和CMA相比（分别为p<0.04和p<0.002）, DRSP对血清SHBG浓度有更大的影响（+218%；p<0.0001）。血清所有组的总睾酮浓度显著降低（p<0.0001）。DRSP对总睾酮浓度的影响显著大于DNG (p = 0.002)和CMA (p < 0.0001)。

结论：我们的研究表明, DNG对SHBG浓度具有重要的刺激作用, 小于DRSP, 但大于CMA。对于脱氢表雄酮硫酸盐和总睾酮也起到了类似的作用。

Keywords:

• Dienogest
• hyperandrogenism
• oral contraceptives
• PCOS
• SHBG

Disclosure statement

No potential conflict of interest was reported by the author(s).