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Glucose Metabolism and Insulin Resistance in Women with Polycystic Ovary Syndrome during Therapy with Oral Contraceptives Containing Cyproterone Acetate or Desogestrel

Institute of Obstetrics and Gynecology, Policlinico di Modena (A.C., A.R., A.V.), 41100 Modena, Italy; and Institute of Obstetrics and Gynecology, University of Cagliari (A.M.P., M.O., M.P., G.B.M.), 09124 Cagliari, Italy

Address all correspondence and requests for reprints to: Dr. Angelo Cagnacci, Dipartimento Misto Materno Infantile, Ginecologia e Ostetricia, Policlinico di Modena, Via del Pozzo 71, 41100 Modena, Italy. E-mail: cagnacci{at}unimore.it.

Oral contraceptives slightly deteriorate insulin sensitivity. The present study investigated whether they may further unbalance the glucose metabolism of lean women with polycystic ovary syndrome (PCOS). Women with PCOS were assigned to receive for 6 months the biphasic association of 40/30 µg ethinyl estradiol (EE) and 25/125 µg desogestrel (DSG; n = 10) or the monophasic association of 35 µg EE and 2 mg cyproterone acetate (CPA; n = 10). Glucose tolerance was investigated by an oral glucose tolerance test (OGTT). Glucose utilization dependent [insulin sensitivity (SI)] or independent (Sg) of insulin was investigated by the minimal model method applied to a frequently sampled iv glucose tolerance test. EE/DSG increased the response of C peptide to OGTT (1413 ± 113 vs. 2053 ± 213 area under the curve; P < 0.009) and the C peptide/insulin ratio (0.085 ± 0.01 vs. 0.134 ± 0.01 area under the curve; P < 0.003). It also increased the Sg (0.026 ± 0.002 vs. 0.034 ± 0.003; P < 0.04) and decreased the SI (2.40 ± 0.26 vs. 1.68 ± 0.27; P < 0.01). EE/CPA did not modify responses to OGTT of glucose, insulin, C peptide, or C peptide/insulin ratio. It did not modify Sg and significantly increased SI (1.47 ± 0.38 vs. 3.27 ± 0.48; P < 0.04). The present study indicates that EE/CPA improves SI, whereas EE/DSG impairs SI, but improves insulin clearance. The long-term metabolic effects of these two compounds on women with PCOS require further investigations.

Abbreviations: AUC, Area under the curve; CPA, cyproterone acetate; DSG, desogestrel; EE, ethinyl estradiol; FSIGT, frequently sampled iv glucose tolerance test; OC, oral contraceptive; PCOS, polycystic ovary syndrome; Sg, glucose utilization-independent on insulin; SI, insulin sensitivity.

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