Comparison of ovarian electrocautery and oral contraceptives in the treatment of hyperandrogenism in women with polycystic ovary syndrome

Background. Endocrine treatment of hyperandrogenism in women with polycysti c ovary syndrome (PCOS) aims at reduction of androgens and increasing sex h ormone binding globuline (SHBG), which are also side effects of ovarian ele ctrocautery (OE) when used for induction of ovulation. Methods. Hormonal effects of ovarian electrocautery were compared with the effects of oral contraceptives (OC) containing desogestrel (DG) or cyproter on acetate (CPA). OCs were given to 18 women with PCOS as their sole treatm ent (group A) and to 23 women after the restoration of regular ovulatory cy cling by ovarian electrocautery (group B). Results. Ovarian electrocautery induced ovulation and increased the concent ration of estrogens and especially progesterone, while OC induced the oppos ite effects. In the androgens and SHBG the two treatments induced changes t hat were in the same direction, but OC treatment induced changes that excee ded those of OE. The concentration of SHBG increased from 27.9 to 127.7 nmo l/L on OC treatment (Group A), compared with 37.2 to 44.9 after OE (Group B ). The androgens decreased, for testosterone the decreases were 2.1 and 0.9 9 nmol/L, respectively, for androsterone 5.36 and 3 nmol/L, for dihydrotest osterone 0.12 and 0.1 nmol/L, and for DHEAS 3.28 and 1.8 umol/L. No further gain was obtained by the combination of the two treatments. Conclusions. Hyperandrogenism in women with PCOS can be effectively treated with OCs containing DG or CPA. In women with concurrent infertility, howev er, ovarian electrocautery can be recommended. The only indication for the combination of these two treatments is ambivalence with regard to the ferti lity after ovulation induction by OE. A temporary delay of ovulatory cyclin g with OC-treatment after OE has no negative impact upon the future fertili ty.