Background: Oligo-ovulatory androgen excess in women (polycystic ovary syndrome (PCOS) by NIH definition) is a major cause of subfertility and relates to hepatic steatosis, independently of obesity.
Objective: To test whether early treatment of PCOS affects subsequent ovulation rate.
Method: Adolescent girls with hyperinsulinemic androgen excess a subgroup of PCOS (mean age 16 year; BMI 23.7 kg/m2) randomly received standard treatment (oral contraceptive; OC; n=17) or a low-dose combination of spironolactone (50 mg/d), pioglitazone (7.5 mg/d) and metformin (850 mg/d) (SPIOMET; n=17) for 12 months, with follow-up for 6 months.
Results: Both interventions reduced androgen excess without changing body weight, lean mass or total fat (by DXA), but SPIOMET was accompanied by loss of hepatic and visceral fat (by MRI) toward normal. Ovulation rates (assessed by salivary progesterone, 36 months post-treatment) were 2.5-fold higher after SPIOMET than after OC (with normovulation in 94% vs 29%), and they associated closely to on-treatment loss of hepatic fat.
Conclusion: Early in hyperinsulinemic androgen excess, normalization of central fat was followed by a normal ovulation rate.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology