Does obesity diminish the positive effect of oral contraceptive treatment on hyperandrogenism in women with polycystic ovarian syndrome?

Polycystic ovarian syndrome (PCOS) is an obvious indication for long-term t reatment. Combined oral contraceptives (COC) remain the first choice for th e treatment of hyperandrogenism in most patients. However, differences in e ndocrine and metabolic parameters between obese and lean patients have been postulated. This is the first study evaluating the effect of COC treatment in obese versus non-obese PCOS patients, In total, 28 lean [body mass inde x (BMI) < 25 kg/m(2))] and 15 obese (BMI > 30 kg/m(2)) women patients were enrolled in the study. The concentrations of androgens, sex hormone-binding globulin (SHBG) and lipids were measured before and after 6 months of trea tment with COC containing low-androgenic progestins, Clinical androgenic sy mptoms were monitored, There was a lower concentration of SHBG in obese pat ients, but there were no differences in androgen concentrations between bot h groups before the study, Highly significant changes in concentrations of testosterone (P < 0.001), androstenedione (P < 0.0001), SHBG (P < 0.001) an d LH (P = 0.01) were demonstrated in lean patients,,vith only less signific ant changes in SHBG (P < 0.01) and testosterone (P < 0.05) in obese patient s during the study. Clinical androgenic symptoms improved significantly (P = 0.05) only in the group of lean women. No reduction in low-density lipopr otein-cholesterol/high-density lipoprotein-cholesterol ratio was observed i n either group, In conclusion, the positive effect of COC treatment on andr ogen production, serum androgen binding capacity, and clinical androgenic s ymptoms was negatively influenced by an increased BMI.