ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2003) 5 P194

Insulin sensitivity in polycystic ovary syndrome-influence of peroral versus transdermal estrogen treatment

J Vrbikova, S Stanicka, K Dvorakova, M Hill, K Vondra & L Starka

Institute of Endocrinology, Prague, Czech Republic.

Aim: To compare influence of transdermal versus peroral estrogen treatment on insulin sensitivity, lipid and hormonal levels in women affected with polycystic ovary syndrome (PCOS).
Patients and Methods: 17 women with PCOS, age 24.8 (4.2) years, BMI 24.15 (3.68) were randomly assigned either for peroral (8) or transdermal (9 patients) estrogens in conjunction with cyproteronacetate. In the early follicular phase of menstrual cycle before and then after 3 month of treatment basal blood samples and euglycaemic hyperinsulinaemic clamp with determination of metabolic clearance rate of glucose (MCRG) and insulin sensitivity index (ISI) were done. Statistics: ANOVA and Student t-test or Wilcoxon test. Results are given as mean (SD)
Results: After peroral treatment, the body weight did not significantly change: 64.5 (10.0) to 64.8 (9.6) kg. MCRG and ISI decreased significantly (8.80 (1.32) to 6.51 (2.28) ml/kg/min; p=0.051 and 119.6 (37.7) to 96.42 (40.31) micromol/kg/min/mIU;p =0.04). Fasting insulin (6.0 (2.6) to 9.1 (4.3) mIU/l; p=0.04), triglycerides (0.71 (0.15) to 1.07 (0.31) mmol/l; p= 0.02) and SHBG (40.7 (19.4) to 170.9 (48.2) nmol/l; p(0.001) significantly increased.
After transdermal application of estrogens, no significant change in weight (69.3 (14) to 69.7(15) kg), MCRG (8.41(2.44) to 8.71 (1.54) ml/kg/min) or ISI (126 (37) to 136 (48) micromol/kg/min/mIU) was observed. Cholesterol (4.72 (0.48) to 3.94 (0.48) mmol/l; p=0.009), HDL-cholesterol (1.36 (0.25) to 1.23 (0.24) mmol/l; p =0.008) and triglycerides (0.81 (0.21) to 0.75 (0.24) mmol/l;p=0.04) decreased significantly. Tendency towards a decrease in testosterone (2.52 (0.66) to 1.98 (0.55) nmol/l; p= 0.07) and no change in SHBG levels (40.7 (22) to 37.1 (17.7) nmol/l) was found.
Conclusions: In non-obese women with PCOS, peroral estrogens (at doses common in combined oral contraceptives) led to a significant impairment in insulin action. On the contrary, transdermal application of estrogens did not significantly influence insulin sensitivity.
Supported by grant of Czech Ministry of Health, NB/6696-3,after approval of Ethic comittee

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