Endocrine Abstracts

Background: Women with PCOS carry cardiovascular (CV) risk factors, which may account for the increased CV risk. Oral contraception therapy using ethinyl-estradiol & cyproterone acetate (EE-CA) is administrated to normalize menstrual cycles and reduce serum androgen levels in women with PCOS. The aim of this study was to assess the effect of EE-CA on endothelial function in young, non-obese PCOS women.

Methods: We studied 13 non-obese (body mass index <25 kg/m²), young women with PCOS before and after 6 months of EE-CA therapy and we compared them with14 age- and BMI-matched women with normal ovarian function. All women were non-smokers and free of CV disease. Endothelium-dependent flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) was assed in all women, using high resolution linear array ultrasound in the brachial artery at baseline and at 6 months.

Results: At baseline both groups did not differ in fasting glucose and insulin, indices of insulin sensitivity, serum lipids and blood pressure. FMD was significantly lower in women with PCOS at baseline (increase in brachial artery diameter during hyperemia by 4.67±2.38%) than in control women (increase by 10.12±3.19%, P<0.0005). NMD was also lower in women with PCOS (18.45±5.42% vs 25.04±4.42%, respectively, P=0.003). Following EE-CA therapy for 6 months, FMD was improved in women with PCOS, increasing by approximately two-fold (9.99+2.11%, P<0.005 compared to pre-treatment), and reaching normal values (P not significant compared to control women). NMD did not change significantly following treatment. EE-CA therapy resulted in a significant decrease in free androgen index (14.1±13.8% vs 2.3±1.3%, P=0.019). EE-CA therapy did not have any effect on BMI, blood pressure, fasting glucose, insulin and indices of insulin sensitivity.

Conclusions: Early onset of endothelial dysfunction in young, non-obese women with PCOS may increase their risk for cardiovascular disease. Treatment with EE-CA for 6 months has a beneficial effect on endothelial function, possibly due to reduced androgen levels.