METABOLIC EFFECTS OF ORAL-CONTRACEPTIVES IN WOMEN WITH POLYCYSTIC-OVARY-SYNDROME

Insulin resistance and dyslipidemia have been described in women with polycystic ovary syndrome (PCOS), a disorder characterized by hyperand rogenism and oligomenorrhea. Although oral contraceptives (OC) are oft en instituted to regulate menses and suppress HA in women with PCOS, t heir use has been postulated to cause a deterioration in insulin sensi tivity and to adversely affect circulating lipids. To investigate thes e effects, 9 women with PCOS and 10 age and weight-matched control wom en mere studied before and during the third month of therapy with a lo w-dose norethindrone-containing triphasic combination OC using the hyp erglycemic clamp technique. At baseline, the PCOS group had higher and rogen, triglyceride, and glycosylated hemoglobin concentrations, with a greater insulin response to oral glucose and a lower insulin sensiti vity index (ISI) than controls. During OC therapy, a reduction in LSI was observed in both groups, whereas an increase in triglycerides was observed only in controls, removing any observed difference between th e two groups in ISI or lipids. In women with PCOS, an increase in insu lin concentrations during hyperglycemia accounted for the decline in I SI (P = 0.026), whereas in control women the decrease in ISI was attri butable to a decrease in glucose disposal (P = 0.004). In conclusion, PCOS is characterized by insulin resistance in the untreated state. Sh ort-term therapy with a triphasic OC results in a further decline in I SI in women with PCOS, without inducing additional adverse effects on lipids. A more pronounced decline in ISI together with an elevation in triglyceride levels occurs in normal women with OCs. The mechanisms l eading to this decrease in ISI are different for each group.