Abstract

EFFECTS OF METFORMIN AND ETHINYL ESTRADIOL–CYPROTERONE ACETATE ON LIPID LEVELS AND SERUME TESTOSTERONE ASSESMENT IN OBESE WOMEN WITH POLYCYSTIC OVARY SYNDROME 2019

Dr. Fatimah Mohammad Ali Al Momen*, Dr. Alaa Hadi Kadim Hammodi, Dr. Saad Salah Aldeen Mustafa

ABSTRACT

Objective: 1.Women with polycystic ovary syndrome (PCOS) exhibit risk factors for cardiovascular diseases such as abdominal obesity, insulin resistance and dyslipidemia. Insulin sensitizers, especially metformin, have been shown to improve these metabolic disturbances, but there are only a few studies on their effects on serum lipids in polycystic ovary syndrome. 2. In this randomized, double-blind, placebo controlled study, 19 overweight women with PCOS were randomized to a 3-month course of either metformin plus combined hormonal oral contraceptive (OC) (n=9) or OC and matched placebo (n=10). After 3 months, both treatments had similar effects on androgen levels, lipid profile, insulin sensitivity and serum inflammatory markers, but flow-mediated dilatation increased by 69.0% in the metformin-OC group (p=0.01) while it remained unchanged in the OC group. Methods: Thirty-five women with PCOS (18 obese and 17 non-obese) were randomized to 6-month treatments with metformin or ethinyl estradiol–cyproterone acetate oral contraceptive pills. Results: In the whole-study population (non-obese and obese women) serum levels of high-density lipoprotein cholesterol increased from 1.4^0.2 to 1.6^0.1 mmol/l (means^S.E. throughout) at 3 and 6 months (P , 0.001), the total cholesterol:high-density lipoprotein cholesterol ratio decreased significantly from 3.8^0.3 to 3.3^0.2 at 6 months (P , 0.001) and a similar trend was observed in serum triglyceride levels during metformin treatment. In the oral contraceptive group, serum levels of total cholesterol increased from 4.9^0.3 to 5.4^0.3 mmol/l (P , 0.05), high-density lipoprotein cholesterol increased from 1.2^0.1 to 1.5^0.1 mmol/l (P , 0.001), the total cholesterol:high-density lipoprotein cholesterol ratio decreased from 4.6^0.4 to 3.7^0.2 (P, 0.001) and triglycerides increased from 1.3^0.1 to 1.9^0.2 mmol/l at 6 months of treatment (P, 0.001). Serum low-density lipoprotein cholesterol levels remained unchanged during both treatments. Milder but similar changes in the subgroups of obese and non-obese women were observed during both treatments. Moreover, in the whole-study population both systolic (P ¼ 0.02) and diastolic (P ¼ 0.05) blood pressures decreased over the 6 months of metformin treatment. Conclusion: In women with PCOS, metformin treatment had beneficial effects on lipid profile and blood pressure, and therefore it could be useful in the prevention of cardiovascular complications in these women.

Keywords: metformin; oral contraceptives; endothelial function; insulin sensitivity.