Effects of Cyproterone Compound-spironolactone, Metformin and Pioglitazone on Inflammatory Markers in PCOS

Polycystic ovary syndrome (PCOS) is estimated to affect up to10% of women of reproductive age, making it one of the most common endocrine disorders in this population. PCOS is associated with a broad range of adverse sequel, including hypertension, dyslipidemia, insulin resistance, hyperandrogenaemia, gestational and type 2 diabetes,which ultimately increase the cardiovascular morbidity in these patients. Also PCOS is increasingly recognized as a component of the metabolic syndrome. Management depends on symptoms or the source of androgen excess. Several treatment options are available, which allows for an individualized approach. Spironolactone is the safest potent available antiandrogen. It is effective in lowering the hirsutism score by approximately one third, although considerable individual variations exist. Other antiandrogens used to treat hirsutism and hirsutism equivalents include cyproterone acetate that has weak antiglucocorticoid effects. Metformin and thiazolidinediones, are promising adjuncts for treating PCOS. Although both of them increase insulin sensitivity, but their mechanism of action differ.

Serum complement, homocysteine and C-reactive protein (CRP) levels have been reported to be linked with insulin resistance.

The investigators want to measure serum complement, homocysteine and hs-CRP levels in patients with PCOS before and after three-month course of treatment with Cyproterone compound-Spironolactone (CC-S), metformin (M) and pioglitazone (P).

Inclusion criteria

• Age 18-35 years
• Diagnosis of Polycystic Ovary Syndrome (PCOS) according to Rotterdam criteria 2003 (two out of three required):

• Oligomenorrhea or anovulation
• Clinical and/or biochemical signs of hyperandrogenism
• Polycystic ovaries (by ultrasound)

Exclusion criteria

• Smoking
• Pregnancy
• Diabetes mellitus
• Renal failure (serum creatinine >1.5)
• Congenital adrenal hyperplasia
• Hyper or hypothyroidism
• Sex hormone therapy or antiandrogen therapy during the last three months
• Unexplained serum alanin aminotransferase (ALT) elevation more than 2.5 times above normal range
• Any systemic or febrile illnesses
• Use of glucocorticoid or anti-inflammatory drugs during the last three months
• Androgen secreting tumor
• Malignancy