Polycystic ovarian syndrome (PCOS) is very common in girls and women of reproductive age and is a major cause of female subfertility. While no treatment is authorized for PCOS, about 98% of the girls who have it, regardless of whether they are sexually active, take a combined oral contraceptive pill that contains an estrogen and a progestin. In adolescent girls with PCOS, bringing the amount of abdominal visceral fat and liver fat to normal ovulation restoration, normalizes the symptoms of excess androgen and can help prevent future subfertility, suggests new research from Spain. In a study conducted at the University of Barcelona, Dr. Ibáñez and her colleagues enrolled 36 young women with PCOS who on average were 16 years of age, were non-obese and not sexually active. They had had their first menstrual cycle at least two years ago; and their excessive hair and irregular menstruation could not be attributed to specific causes.
Participants were randomized to receive one of the two drug combinations per day: some took a combined oral contraceptive pill containing 20 mcg ethinylestradiol + 100 mg levonorgestrel; others took SPIOMET (spironolactone 50 mg + pioglitazone 7.5 mg + and metformin 850 mg). The girls were also encouraged to exercise regularly and follow a Mediterranean diet. They took the drugs for 12 months and were followed without intervention for another 12 months. Referring to menstrual diaries and weekly measurements of salivary progesterone, the researchers counted the number of two-stage ovulations: between 3 and 6 months after treatment and between 9 and 12 months after treatment. The authors also assessed body composition; the amount of abdominal, visceral and hepatic fat; thickness of the carotid artery; blood markers such as cholesterol, androgens, insulin and other cardiovascular health indicators.
Prior to treatment, young women with PCOS had more visceral and hepatic fat than the corresponding age controls, as well as higher androgens and insulin and altered cardiovascular markers. During treatment, those taking SPIOMET normalized more hepatic and visceral fat, insulin and cardiovascular health markers; and after treatment, these values remained more normal in girls who took SPIOMET than those with oral contraceptives. Compared to oral contraceptives, SPIOMET was followed by an ovulation rate of 2.5 times higher and a prevalence 6 times higher than normal ovulation; and the risk of having abnormally few ovulations was 65% lower. The girls who lost more hepatic fat were the ones who ovulated more after treatment.
PCOS is usually associated with insulin resistance. Recent studies have reported that women with PCOS receiving metformin have improved pregnancy outcomes, and this has been attributed to its ability to reduce insulin resistance as well as hyperinsulinemia. The latter is the factor considered most responsible for the high presence of androgens (male hormones), which in turn cause hair, irregular menstruation and infertility to appear. Although all the mechanisms of metformin are not known, its presence can contribute to improving the maturation of oocytes in PCOS, exerting a definitive favorable effect on infertility due to an inefficient maturation of the oocytes. Dr. Ibáñez concluded: “If SPIOMET can restore ovulation rates after reducing excess fat, subsequent subfertility can be prevented in many women who today depend on costly and time-consuming fertility techniques to conceive.”
- edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
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