Ethinylestradiol(30μg)-drospirenone and metformin: could this combination improve endothelial dysfunction in polycystic ovary syndrome?

BACKGROUND: We are hereby investigating for the first time the effect of the association ethinylestradiol(30μg)-drospirenone (3mg) (DRP/EE(30μg)) plus metformin and weight loss on endothelial status and C-reactive protein (hsCRP) levels in polycystic ovary syndrome (PCOS). METHODS: 25 young women with PCOS (mean age 22.76 ± 0.83 years, body mass index (BMI): 28.44 ± 6.23) who completed the study were prospectively evaluated. The oral contraceptive- DRP/EE(30μg) (21 days/month) and metformin (1700 mg daily) were administered for 6 months to the PCOS group. Additionally, the 15 overweight and obese patients (BMI > 25 kg/m2) were instructed in a diet of no more than 1500 cal daily. Primary outcome measures were surrogate markers of cardiovascular disease and included endothelial function, i.e. flow-mediated dilatation (FMD) on the brachial artery and endothelin-1 levels, as well as hsCRP concentrations, body composition (measured by whole-body dual-energy X-ray-absorptiometry) and insulin resistance. Variables were assessed at baseline, as well as after our medical intervention. RESULTS: The combination between DRP/EE(30μg) plus metformin combined with weight loss triggered a significant improvement in the FMD values (FMD-PCOS(basal) 3.48 ± 1.00 vs FMD-PCOS(6 months)7.43 ± 1.04, p = 0.033), as well as body composition and insulin insensitivity (p < 0.05). Regarding hsCRP levels, there was no significant intragroup (PCOS(6months) – PCOS(basal)) difference. CONCLUSION: A 6-month course of metformin- DRP/EE(30μg ()associated with weight loss) improves the endothelial dysfunction in PCOS and shows neutral effects on hsCRP concentrations as an inflammation marker. These data demand for reevaluation of the medical therapy in PCOS, particularly in women with additional metabolic and cardiovascular risk factors (ClinicalTrials.gov Identifier: NCT01459445).