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01 August 2012

Oral contraceptives and PCOS

Some types of oral contraceptives appear to have the strongest effect on women with PCOS.

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Over the long term, oral contraceptives containing cyproterone acetate appear to have the strongest anti-androgenic properties in women with Polycystic Ovary Syndrome (PCOS), according to Indian researchers.

But in the first few months of treatment, they say, pills containing desogestrel, cyproterone acetate, and drospirenone have similar effects.

"We found in our clinical practice that many clinicians get confused about which pill to select," Dr Sudhindra Mohan Bhattacharya said. In a paper online in Fertility and Sterility, he and his colleague Dr Ayan Jha address that problem.

Dr Bhattacharya of S. C. Das Memorial Medical and Research Centre, Kolkata, and Dr Jha of the Indian Council of Medical Research, New Delhi, enrolled 171 women and randomly assigned them to desogestrel, cyproterone acetate, and drospirenone groups.

At six months, results were similar, but at 12 months, cyproterone acetate significantly decreased the modified Ferriman Galwey score compared with both desogestrel and drospirenone.

Cyproterone and drospirenone also significantly increased sex hormone-binding globulin compared with desogestrel.

In addition, cyproterone significantly decreased the Free Androgen Index compared with desogestrel. Overall, effects on metabolic parameters were identical.

Thus, Dr Bhattacharya advises, given the lack of difference in immediate anti androgenic effects "the clinician can choose any one if he/she decides to use it for a short time, say, six months." He notes that the desogestrel pill is cheaper than the other two.

At 12 months, however, "desogestrel lags behind the other two pills in its anti-androgenic effects," and "cyproterone is much stronger than drospirenone."

Thus, Dr Bhattacharya concludes, in "any women with strong androgenic manifestations, it will be advisable to start with cyproterone acetate. For those with milder degrees of androgenic features, one can select drospirenone."

(Reuters Health, July 2012)

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