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• W2070736606 abstract "In this study, discontinuation of oral contraceptive pills in women with polycystic ovary syndrome was followed by the return of all measured androgens and sex hormone-binding globulin levels to basal values after 8 weeks. These observations are pertinent to the measurement of androgens and sex hormone-binding globulin levels in subjects who currently are taking oral contraceptive pills and have symptoms that are related to polycystic ovary syndrome. In this study, discontinuation of oral contraceptive pills in women with polycystic ovary syndrome was followed by the return of all measured androgens and sex hormone-binding globulin levels to basal values after 8 weeks. These observations are pertinent to the measurement of androgens and sex hormone-binding globulin levels in subjects who currently are taking oral contraceptive pills and have symptoms that are related to polycystic ovary syndrome. Androgen excess is probably the most common endocrine disorder of reproductive age women, affecting approximately 7% of this population (1Azziz R. Woods K.S. Reyna R. Key T.J. Knochenhauer E.S. Yildiz B.O. The prevalence and features of the polycystic ovary syndrome in an unselected population.J Clin Endocrinol Metab. 2004; 89: 2745-2749Crossref PubMed Scopus (1940) Google Scholar, 2Diamanti-Kandarakis E. Kouli C.R. Bergiele A.T. Filandra F.A. Tsianateli T.C. Spina G.G. et al.A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile.J Clin Endocrinol Metab. 1999; 84: 4006-4011Crossref PubMed Google Scholar, 3Asuncion M. Calvo R.M. San Millan J.L. Sancho J. Avila S. Escobar-Morreale H.F. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain.J Clin Endocrinol Metab. 2000; 85: 2434-2438Crossref PubMed Scopus (1140) Google Scholar). Most women with androgen excess have polycystic ovary syndrome (PCOS) (4Azziz R. Sanchez L.A. Knochenhauer E.S. Moran C. Lazenby J. Stephens K.S. et al.Androgen excess in women: experience with over 1000 consecutive patients.J Clin Endocrinol Metab. 2004; 89: 453-462Crossref PubMed Scopus (600) Google Scholar), which is a chronic condition with long-term consequences that include diabetes mellitus, increased risk for cardiovascular disease, subfertility, and endometrial cancer (5Ovalle F. Azziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus.Fertil Steril. 2002; 77: 1095-1105Abstract Full Text Full Text PDF PubMed Scopus (322) Google Scholar, 6Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis.Endocr Rev. 1997; 18: 774-800Crossref PubMed Scopus (2236) Google Scholar, 7Talbott E. Guzick D. Clerici A. Berga S. Detre K. Weimer K. et al.Coronary heart disease risk factors in women with polycystic ovary syndrome.Arterioscler Thromb Vasc Biol. 1995; 15: 821-826Crossref PubMed Scopus (430) Google Scholar, 8Talbott E.O. Guzick D.S. Sutton-Tyrrell K. McHugh-Pemu K.P. Zborowski J.V. Remsberg K.E. Kuller L.H. Evidence for association between polycystic ovary syndrome and premature carotid atherosclerosis in middle-aged women.Arterioscler Thromb Vasc Biol. 2000; 20: 2414-2421Crossref PubMed Scopus (447) Google Scholar, 9Hamilton-Fairley D. Taylor A. Anovulation.Br Med J. 2003; 327: 546-549Crossref PubMed Scopus (12) Google Scholar). Making an early and correct diagnosis potentially may contribute to diminish the severity of those consequences. Frequently, women who complain of symptoms that are related to PCOS are taking oral contraceptive pills (OCP), either for contraceptive purposes or for treatment of irregular cycles. These drugs cause suppression of the ovarian function and, consequently, of androgen synthesis. Under these circumstances, it has been recommended to discontinue the use of OCP for a variable period of time to obtain a reliable measurement of androgens and sex hormone-binding globulin (SHBG) levels. To our knowledge, there has been only 1 study that has measured androgen levels after the discontinuation of OCP in women with PCOS, and that was several decades ago (10Givens G.R. Andersen R.N. Wiser W.L. Fish S.A. Dynamics of suppression and recovery of plasma FSH, LH, androstenedione and testosterone in polycystic ovarian disease using an oral contraceptive.J Clin Endocrinol Metab. 1974; 38: 727-735Crossref PubMed Scopus (85) Google Scholar). However, in that study only 2 androgens were determined (total testosterone and androstenedione); measurements were performed only during the first 12 days after the discontinuation of OCP (a very short period of time), and as it was expected, after 12 days androgen levels remained significantly lower compared with pretreatment values. Therefore, it remains unknown how long it takes the androgens to return to basal values after the discontinuation of OCP in women with PCOS. To determine the time that serum androgens and SHBG take to return to baseline levels, we measured them prospectively every 4 weeks until these values went back to basal conditions in a group of women with PCOS who had stopped taking OCP. All subjects signed a consent form. The study was performed in a private practice center, and approval from a Review Board was not obtained. The study population consisted of 8 subjects with a diagnosis of PCOS who were assigned to receive a combination OCP composed of drospirenone 3 mg and ethinyl-estradiol 30 μg for 12 weeks. At the end of this period, the subjects discontinued OCP use and were evaluated for 8 weeks. To ensure that we measured basal androgens and SHBG levels, all patients had at least 12 weeks without any hormonal treatment and normal thyroid-stimulating hormone and prolactin levels before they entered the study protocol, and a basal serum sample was obtained. The diagnosis of PCOS was established by the presence of hyperandrogenism (clinical or biochemical), chronic ovulatory dysfunction, and exclusion of other related conditions (21-OH–deficient nonclassic adrenal hyperplasia, ovarian-adrenal tumors, and Cushing’s syndrome) in accordance with the criteria suggested by a 1990 National Institutes of Health conference (11Zawadzki J.K. Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach.in: Dunaif A. Givens J.R. Haseltine F. Merriam G.R. Polycystic ovary syndrome. Blackwell Scientific Publications, Boston1992: 377-384Google Scholar). Serum samples were collected prospectively before and at week 12 of treatment and at 4 and 8 weeks after discontinuation of OCP. Samples were frozen at –20°C and kept in the freezer until all assays were run together. We measured total and free testosterone, DHEAS, and SHBG levels by ELISA and RIA. The statistical analysis was performed with KwikStat-4 Statistical Data Analysis Program (TexaSoft, Cedar Hill, TX). Hormonal values that were obtained at week 12 of treatment and at weeks 4–8 after discontinuation of OCP were compared by the T test to those values that had been measured at baseline. Eight women with PCOS entered the study, and 7 women completed the entire protocol. The mean age was 26.29 years. Mean body mass indexes at basal conditions and end of treatment period were 24.35 and 24.29 kg/m2, respectively (P=.86). The Ferriman-Gallwey score decreased during the treatment period, but the change did not reach significance (mean baseline and posttreatment values, 4.14 and 3.86; P=.36). Mean initial level and the levels after 12 weeks of treatment for total testosterone, free testosterone, DHEAS, and SHBG were 4.14 nmol/L (119 ng/dL) and 1.9 nmol/L (55 ng/dL), 0.01 nmol/L (0.28 ng/dL) and 0.004 nmol/L (0.11 ng/dL), 4.4 μmol/L (1.64 μg/mL) and 2.84 μmol/L (1.05 μg/mL), and 59 nmol/L and 311 nmol/L, respectively. After discontinuation of OCP, androgen levels increased progressively at weeks 4 and 8 of follow-up evaluation. Levels of total testosterone (3.72 nmol/L = 107 ng/dL) and DHEAS (3.81 μmol/L = 1.40 μg/mL) at week 4 were not significantly different from those measured at baseline. Alternatively, free testosterone (0.008 nmol/L = 0.22 ng/dL) and SHBG (54 nmol/L) returned to levels not significantly different from those obtained before treatment, only at week 8 after discontinuation of OCP (Table 1).TABLE 1Hormonal parameters before and after 12 weeks of treatment with OCP and during the follow-up period.HormoneBaselineWeek 12 of treatmentP valueWeek 4 of follow upP valueWeek 8 of follow upP valueTotal testosterone (ng/dL)119.055.0.002107.0aValues are not significantly different from those that were obtained at baseline..391.0aValues are not significantly different from those that were obtained at baseline..06Free testosterone (ng/dL)0.280.11.0020.15.010.22aValues are not significantly different from those that were obtained at baseline..13DHEAS (μg/mL)1.641.05.011.40aValues are not significantly different from those that were obtained at baseline..131.54aValues are not significantly different from those that were obtained at baseline..27SHBG (nmol/L)59.0311.00178.0.0354.0aValues are not significantly different from those that were obtained at baseline..34Note: The probability values are compared with baseline levels.Sanchez. Androgens and SHBG post OCP in PCOS. Fertil Steril 2007.a Values are not significantly different from those that were obtained at baseline. Open table in a new tab Note: The probability values are compared with baseline levels. Sanchez. Androgens and SHBG post OCP in PCOS. Fertil Steril 2007. We have determined for the first time how long it takes androgens and SHBG to return to baseline values after discontinuation of OCP in women with PCOS. We demonstrated that women who complain of symptoms that are related to androgen excess who are currently taking OCP must discontinue the medication and remain 8 weeks without any hormonal treatment before we can obtain a reliable measurement of SHBG and androgen levels. These findings may increase our capability for making a correct PCOS diagnosis. Our study has some strengths: Data were collected prospectively; subjects had a long time without any treatment (12 weeks) before basal hormonal values were obtained; and they took OCP for 3 months (12 weeks), which produced an adequate suppression of ovarian androgens. At the same time, our results have a few limitations: They may not apply to another kind of OCP with a different hormonal dose or progestin type. In conclusion, in this population of women with PCOS, the discontinuation of an OCP composed of drospirenone 3 mg and ethinyl-estradiol 30 μg was followed by the return of total testosterone and DHEAS to baseline levels in 4 weeks. However, free testosterone and SHBG levels returned to basal values at only 8 weeks after discontinuation of medication. These observations are pertinent when androgens and SHBG level are measured in subjects who currently are taking OCP for contraception purposes or for irregular menstrual cycles and who have symptoms that are related to PCOS." @default.
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• W2070736606 title "Determining the time androgens and sex hormone-binding globulin take to return to baseline after discontinuation of oral contraceptives in women with polycystic ovary syndrome: a prospective study" @default.
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