A comparison of the effects of oral contraceptives on the clinical and biochemical manifestations of polycystic ovary syndrome: a crossover randomized controlled trial
Abstract STUDY QUESTION Do oral contraceptives (OCs) containing progestins with low androgenic or antiandrogenic activities have different effects to those containing levonorgestrel (LNG) on clinical, androgenic and metabolic manifestations of polycystic ovarian syndrome (PCOS)? SUMMARY ANSWER The t...
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| Veröffentlicht in: | Human reproduction (Oxford) 2020-01, Vol.35 (1), p.175-186 |
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| creator | Amiri, Mina Nahidi, Fatemeh Bidhendi-Yarandi, Razieh Khalili, Davood Tohidi, Maryam Ramezani Tehrani, Fahimeh |
| description | Abstract
STUDY QUESTION
Do oral contraceptives (OCs) containing progestins with low androgenic or antiandrogenic activities have different effects to those containing levonorgestrel (LNG) on clinical, androgenic and metabolic manifestations of polycystic ovarian syndrome (PCOS)?
SUMMARY ANSWER
The three OCs tested had similar effects on clinical findings of hyperandrogenism (HA), whereas products containing LNG were less effective on androgenic profiles and had detrimental effects on lipid profiles.
WHAT IS KNOWN ALREADY
Despite data available on the effects of OCs, the superiority of products with low androgenic or antiandrogenic progesterone components in comparison with older products used in women with PCOS has not been clarified.
STUDY DESIGN, SIZE, DURATION
This study is a crossover randomized controlled six-arm trial, with all six arms including two 6-month treatment periods, one period with OCs containing LNG, and the other with one of three OCs containing desogestrel (DSG), cyproterone acetate (CPA) or drospirenone (DRSP). The trial was conducted between February 2016 and January 2018 and enrolled 200 patients with PCOS.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Two hundred women with PCOS (ages 18–45 years) were recruited at the endocrine outpatient clinic of the Research Institute for Endocrine Sciences (RIES) of the Shahid Beheshti University of Medical Sciences, Tehran, Iran. A blocking or stratification random allocation (block size = 6) using a computer-based random number generator was prepared to assign participants to treatment groups. Both the clinical examiner and data analyst were blinded to participants during the trial. Outcomes of interest, including anthropometric and clinical manifestations and hormonal, and biochemical parameters were assessed at baseline, after 3 and 6 months of each treatment and after the washout period.
MAIN RESULTS AND THE ROLE OF CHANCE
This study detected a higher decrease in free-androgen index (FAI) levels after 3 months of treatment with OCs containing DSG (95% CI: −2.3, −1.0), CPA (95% CI: −2.4, −1.1) and DRSP (95% CI: −2.6, −1.4), compared with products containing LNG (P |
| doi_str_mv | 10.1093/humrep/dez255 |
| format | Article |
| fullrecord | <record><control><sourceid>oup_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1093_humrep_dez255</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/humrep/dez255</oup_id><sourcerecordid>10.1093/humrep/dez255</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-6172d132a2dc1a7cdbccf6ba62b585f79ae99f3d29ceccca5e6a6e2e0d97f7543</originalsourceid><addsrcrecordid>eNqFkDtPwzAUhS0EgvIYWZFHloDtNE7DViFeEhILzJFzfa0aJXFku5XSP8TfxG2Alem-Pp17dAi55OyGsyq_Xa07j8Otxq0oigMy43PJMpEX7JDMmJCLjHPJT8hpCJ-MpXYhj8lJzisui3I-I19LCq4blLfB9dQZGldI0RiEGHaj86pNRB-9Ahyi3WBa93sKWttbSGfVa9pYByvs9nOnemswRBWt6_cqg2tHGEO0QN1G-ZGGsdfedXhHFQXvQnAb9NQnJdfZLerppWvb1EZvVXtOjoxqA1781DPy8fjwfv-cvb49vdwvXzPIhYyZ5KXQPBdKaOCqBN0AGNkoKZpiUZiyUlhVJteiAgQAVaBUEgUyXZWmLOb5Gckm3b0rj6YevO2S5Zqzehd4PQVeT4En_mrih3XTof6jfxNOwPUEuPXwj9Y30TOS6Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>A comparison of the effects of oral contraceptives on the clinical and biochemical manifestations of polycystic ovary syndrome: a crossover randomized controlled trial</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Amiri, Mina ; Nahidi, Fatemeh ; Bidhendi-Yarandi, Razieh ; Khalili, Davood ; Tohidi, Maryam ; Ramezani Tehrani, Fahimeh</creator><creatorcontrib>Amiri, Mina ; Nahidi, Fatemeh ; Bidhendi-Yarandi, Razieh ; Khalili, Davood ; Tohidi, Maryam ; Ramezani Tehrani, Fahimeh</creatorcontrib><description>Abstract
STUDY QUESTION
Do oral contraceptives (OCs) containing progestins with low androgenic or antiandrogenic activities have different effects to those containing levonorgestrel (LNG) on clinical, androgenic and metabolic manifestations of polycystic ovarian syndrome (PCOS)?
SUMMARY ANSWER
The three OCs tested had similar effects on clinical findings of hyperandrogenism (HA), whereas products containing LNG were less effective on androgenic profiles and had detrimental effects on lipid profiles.
WHAT IS KNOWN ALREADY
Despite data available on the effects of OCs, the superiority of products with low androgenic or antiandrogenic progesterone components in comparison with older products used in women with PCOS has not been clarified.
STUDY DESIGN, SIZE, DURATION
This study is a crossover randomized controlled six-arm trial, with all six arms including two 6-month treatment periods, one period with OCs containing LNG, and the other with one of three OCs containing desogestrel (DSG), cyproterone acetate (CPA) or drospirenone (DRSP). The trial was conducted between February 2016 and January 2018 and enrolled 200 patients with PCOS.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Two hundred women with PCOS (ages 18–45 years) were recruited at the endocrine outpatient clinic of the Research Institute for Endocrine Sciences (RIES) of the Shahid Beheshti University of Medical Sciences, Tehran, Iran. A blocking or stratification random allocation (block size = 6) using a computer-based random number generator was prepared to assign participants to treatment groups. Both the clinical examiner and data analyst were blinded to participants during the trial. Outcomes of interest, including anthropometric and clinical manifestations and hormonal, and biochemical parameters were assessed at baseline, after 3 and 6 months of each treatment and after the washout period.
MAIN RESULTS AND THE ROLE OF CHANCE
This study detected a higher decrease in free-androgen index (FAI) levels after 3 months of treatment with OCs containing DSG (95% CI: −2.3, −1.0), CPA (95% CI: −2.4, −1.1) and DRSP (95% CI: −2.6, −1.4), compared with products containing LNG (P < 0.001). Use of OCs containing DSG (95% CI: −3.6, −1.5), CPA (95% CI: −3.1, −0.8) and DRSP (95% CI: −3.4, −1.1) for 6 months was associated with more decrease in FAI, compared with products containing LNG (P < 0.001). The study showed that use of OCs containing DSG, CPA and DRSP for 3–6 months was associated with a higher increase of sex hormone-binding globulin (SHBG), compared with products containing LNG (P < 0.001). We also observed more decrease in dehydroepiandrosterone sulfate levels after use of OCs containing DSG (P = 0.003), CPA (P = 0.012) and DRSP (P < 0.001) for 6 months, compared with products containing LNG. Our results showed that the use of OCs containing DRSP for 6 months was associated with more improvement in acne, compared with products containing LNG (P = 0.007). Women treated with OCs containing CPA, and DRSP for 3 months had higher TG and HDL levels and lower LDL levels, compared with those treated with products containing LNG (P < 0.05). After 6 months of treatment, patients treated with OCs containing DRSP had a sharper decline in LDL levels and more increase in HDL levels, compared to those treated with products containing LNG (P = 0.001).
LIMITATIONS, REASONS FOR CAUTION
Considering this trial was conducted in women diagnosed with Androgen Excess Society criteria, the results may not be generalizable for mild phenotypes diagnosed using Rotterdam criteria. Other limitations of the study include the high dropout rate, the lack of a gold standard androgen assay and the multiple end points.
WIDER IMPLICATIONS OF THE FINDINGS
Our results support the views of clinicians, who suggest an OC with a low androgenic or antiandrogenic progestin, if available, to treat PCOS.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the RIES, Shahid Beheshti University of Medical Sciences, Tehran, Iran. There are no conflicts of interest.
TRIAL REGISTRATION NUMBER
IRCT201702071281N2.
TRIAL REGISTRATION DATE
21 February 2017.
DATE OF FIRST PATIENT’S ENROLMENT
21 March 2017.</description><identifier>ISSN: 0268-1161</identifier><identifier>EISSN: 1460-2350</identifier><identifier>DOI: 10.1093/humrep/dez255</identifier><identifier>PMID: 31916574</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adolescent ; Adult ; Contraceptives, Oral ; Contraceptives, Oral, Combined - therapeutic use ; Female ; Humans ; Iran ; Levonorgestrel - therapeutic use ; Middle Aged ; Polycystic Ovary Syndrome - drug therapy ; Sex Hormone-Binding Globulin ; Young Adult</subject><ispartof>Human reproduction (Oxford), 2020-01, Vol.35 (1), p.175-186</ispartof><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c326t-6172d132a2dc1a7cdbccf6ba62b585f79ae99f3d29ceccca5e6a6e2e0d97f7543</citedby><cites>FETCH-LOGICAL-c326t-6172d132a2dc1a7cdbccf6ba62b585f79ae99f3d29ceccca5e6a6e2e0d97f7543</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31916574$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Amiri, Mina</creatorcontrib><creatorcontrib>Nahidi, Fatemeh</creatorcontrib><creatorcontrib>Bidhendi-Yarandi, Razieh</creatorcontrib><creatorcontrib>Khalili, Davood</creatorcontrib><creatorcontrib>Tohidi, Maryam</creatorcontrib><creatorcontrib>Ramezani Tehrani, Fahimeh</creatorcontrib><title>A comparison of the effects of oral contraceptives on the clinical and biochemical manifestations of polycystic ovary syndrome: a crossover randomized controlled trial</title><title>Human reproduction (Oxford)</title><addtitle>Hum Reprod</addtitle><description>Abstract
STUDY QUESTION
Do oral contraceptives (OCs) containing progestins with low androgenic or antiandrogenic activities have different effects to those containing levonorgestrel (LNG) on clinical, androgenic and metabolic manifestations of polycystic ovarian syndrome (PCOS)?
SUMMARY ANSWER
The three OCs tested had similar effects on clinical findings of hyperandrogenism (HA), whereas products containing LNG were less effective on androgenic profiles and had detrimental effects on lipid profiles.
WHAT IS KNOWN ALREADY
Despite data available on the effects of OCs, the superiority of products with low androgenic or antiandrogenic progesterone components in comparison with older products used in women with PCOS has not been clarified.
STUDY DESIGN, SIZE, DURATION
This study is a crossover randomized controlled six-arm trial, with all six arms including two 6-month treatment periods, one period with OCs containing LNG, and the other with one of three OCs containing desogestrel (DSG), cyproterone acetate (CPA) or drospirenone (DRSP). The trial was conducted between February 2016 and January 2018 and enrolled 200 patients with PCOS.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Two hundred women with PCOS (ages 18–45 years) were recruited at the endocrine outpatient clinic of the Research Institute for Endocrine Sciences (RIES) of the Shahid Beheshti University of Medical Sciences, Tehran, Iran. A blocking or stratification random allocation (block size = 6) using a computer-based random number generator was prepared to assign participants to treatment groups. Both the clinical examiner and data analyst were blinded to participants during the trial. Outcomes of interest, including anthropometric and clinical manifestations and hormonal, and biochemical parameters were assessed at baseline, after 3 and 6 months of each treatment and after the washout period.
MAIN RESULTS AND THE ROLE OF CHANCE
This study detected a higher decrease in free-androgen index (FAI) levels after 3 months of treatment with OCs containing DSG (95% CI: −2.3, −1.0), CPA (95% CI: −2.4, −1.1) and DRSP (95% CI: −2.6, −1.4), compared with products containing LNG (P < 0.001). Use of OCs containing DSG (95% CI: −3.6, −1.5), CPA (95% CI: −3.1, −0.8) and DRSP (95% CI: −3.4, −1.1) for 6 months was associated with more decrease in FAI, compared with products containing LNG (P < 0.001). The study showed that use of OCs containing DSG, CPA and DRSP for 3–6 months was associated with a higher increase of sex hormone-binding globulin (SHBG), compared with products containing LNG (P < 0.001). We also observed more decrease in dehydroepiandrosterone sulfate levels after use of OCs containing DSG (P = 0.003), CPA (P = 0.012) and DRSP (P < 0.001) for 6 months, compared with products containing LNG. Our results showed that the use of OCs containing DRSP for 6 months was associated with more improvement in acne, compared with products containing LNG (P = 0.007). Women treated with OCs containing CPA, and DRSP for 3 months had higher TG and HDL levels and lower LDL levels, compared with those treated with products containing LNG (P < 0.05). After 6 months of treatment, patients treated with OCs containing DRSP had a sharper decline in LDL levels and more increase in HDL levels, compared to those treated with products containing LNG (P = 0.001).
LIMITATIONS, REASONS FOR CAUTION
Considering this trial was conducted in women diagnosed with Androgen Excess Society criteria, the results may not be generalizable for mild phenotypes diagnosed using Rotterdam criteria. Other limitations of the study include the high dropout rate, the lack of a gold standard androgen assay and the multiple end points.
WIDER IMPLICATIONS OF THE FINDINGS
Our results support the views of clinicians, who suggest an OC with a low androgenic or antiandrogenic progestin, if available, to treat PCOS.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the RIES, Shahid Beheshti University of Medical Sciences, Tehran, Iran. There are no conflicts of interest.
TRIAL REGISTRATION NUMBER
IRCT201702071281N2.
TRIAL REGISTRATION DATE
21 February 2017.
DATE OF FIRST PATIENT’S ENROLMENT
21 March 2017.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Contraceptives, Oral</subject><subject>Contraceptives, Oral, Combined - therapeutic use</subject><subject>Female</subject><subject>Humans</subject><subject>Iran</subject><subject>Levonorgestrel - therapeutic use</subject><subject>Middle Aged</subject><subject>Polycystic Ovary Syndrome - drug therapy</subject><subject>Sex Hormone-Binding Globulin</subject><subject>Young Adult</subject><issn>0268-1161</issn><issn>1460-2350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkDtPwzAUhS0EgvIYWZFHloDtNE7DViFeEhILzJFzfa0aJXFku5XSP8TfxG2Alem-Pp17dAi55OyGsyq_Xa07j8Otxq0oigMy43PJMpEX7JDMmJCLjHPJT8hpCJ-MpXYhj8lJzisui3I-I19LCq4blLfB9dQZGldI0RiEGHaj86pNRB-9Ahyi3WBa93sKWttbSGfVa9pYByvs9nOnemswRBWt6_cqg2tHGEO0QN1G-ZGGsdfedXhHFQXvQnAb9NQnJdfZLerppWvb1EZvVXtOjoxqA1781DPy8fjwfv-cvb49vdwvXzPIhYyZ5KXQPBdKaOCqBN0AGNkoKZpiUZiyUlhVJteiAgQAVaBUEgUyXZWmLOb5Gckm3b0rj6YevO2S5Zqzehd4PQVeT4En_mrih3XTof6jfxNOwPUEuPXwj9Y30TOS6Q</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Amiri, Mina</creator><creator>Nahidi, Fatemeh</creator><creator>Bidhendi-Yarandi, Razieh</creator><creator>Khalili, Davood</creator><creator>Tohidi, Maryam</creator><creator>Ramezani Tehrani, Fahimeh</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20200101</creationdate><title>A comparison of the effects of oral contraceptives on the clinical and biochemical manifestations of polycystic ovary syndrome: a crossover randomized controlled trial</title><author>Amiri, Mina ; Nahidi, Fatemeh ; Bidhendi-Yarandi, Razieh ; Khalili, Davood ; Tohidi, Maryam ; Ramezani Tehrani, Fahimeh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-6172d132a2dc1a7cdbccf6ba62b585f79ae99f3d29ceccca5e6a6e2e0d97f7543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Contraceptives, Oral</topic><topic>Contraceptives, Oral, Combined - therapeutic use</topic><topic>Female</topic><topic>Humans</topic><topic>Iran</topic><topic>Levonorgestrel - therapeutic use</topic><topic>Middle Aged</topic><topic>Polycystic Ovary Syndrome - drug therapy</topic><topic>Sex Hormone-Binding Globulin</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Amiri, Mina</creatorcontrib><creatorcontrib>Nahidi, Fatemeh</creatorcontrib><creatorcontrib>Bidhendi-Yarandi, Razieh</creatorcontrib><creatorcontrib>Khalili, Davood</creatorcontrib><creatorcontrib>Tohidi, Maryam</creatorcontrib><creatorcontrib>Ramezani Tehrani, Fahimeh</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Human reproduction (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Amiri, Mina</au><au>Nahidi, Fatemeh</au><au>Bidhendi-Yarandi, Razieh</au><au>Khalili, Davood</au><au>Tohidi, Maryam</au><au>Ramezani Tehrani, Fahimeh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A comparison of the effects of oral contraceptives on the clinical and biochemical manifestations of polycystic ovary syndrome: a crossover randomized controlled trial</atitle><jtitle>Human reproduction (Oxford)</jtitle><addtitle>Hum Reprod</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>35</volume><issue>1</issue><spage>175</spage><epage>186</epage><pages>175-186</pages><issn>0268-1161</issn><eissn>1460-2350</eissn><abstract>Abstract
STUDY QUESTION
Do oral contraceptives (OCs) containing progestins with low androgenic or antiandrogenic activities have different effects to those containing levonorgestrel (LNG) on clinical, androgenic and metabolic manifestations of polycystic ovarian syndrome (PCOS)?
SUMMARY ANSWER
The three OCs tested had similar effects on clinical findings of hyperandrogenism (HA), whereas products containing LNG were less effective on androgenic profiles and had detrimental effects on lipid profiles.
WHAT IS KNOWN ALREADY
Despite data available on the effects of OCs, the superiority of products with low androgenic or antiandrogenic progesterone components in comparison with older products used in women with PCOS has not been clarified.
STUDY DESIGN, SIZE, DURATION
This study is a crossover randomized controlled six-arm trial, with all six arms including two 6-month treatment periods, one period with OCs containing LNG, and the other with one of three OCs containing desogestrel (DSG), cyproterone acetate (CPA) or drospirenone (DRSP). The trial was conducted between February 2016 and January 2018 and enrolled 200 patients with PCOS.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Two hundred women with PCOS (ages 18–45 years) were recruited at the endocrine outpatient clinic of the Research Institute for Endocrine Sciences (RIES) of the Shahid Beheshti University of Medical Sciences, Tehran, Iran. A blocking or stratification random allocation (block size = 6) using a computer-based random number generator was prepared to assign participants to treatment groups. Both the clinical examiner and data analyst were blinded to participants during the trial. Outcomes of interest, including anthropometric and clinical manifestations and hormonal, and biochemical parameters were assessed at baseline, after 3 and 6 months of each treatment and after the washout period.
MAIN RESULTS AND THE ROLE OF CHANCE
This study detected a higher decrease in free-androgen index (FAI) levels after 3 months of treatment with OCs containing DSG (95% CI: −2.3, −1.0), CPA (95% CI: −2.4, −1.1) and DRSP (95% CI: −2.6, −1.4), compared with products containing LNG (P < 0.001). Use of OCs containing DSG (95% CI: −3.6, −1.5), CPA (95% CI: −3.1, −0.8) and DRSP (95% CI: −3.4, −1.1) for 6 months was associated with more decrease in FAI, compared with products containing LNG (P < 0.001). The study showed that use of OCs containing DSG, CPA and DRSP for 3–6 months was associated with a higher increase of sex hormone-binding globulin (SHBG), compared with products containing LNG (P < 0.001). We also observed more decrease in dehydroepiandrosterone sulfate levels after use of OCs containing DSG (P = 0.003), CPA (P = 0.012) and DRSP (P < 0.001) for 6 months, compared with products containing LNG. Our results showed that the use of OCs containing DRSP for 6 months was associated with more improvement in acne, compared with products containing LNG (P = 0.007). Women treated with OCs containing CPA, and DRSP for 3 months had higher TG and HDL levels and lower LDL levels, compared with those treated with products containing LNG (P < 0.05). After 6 months of treatment, patients treated with OCs containing DRSP had a sharper decline in LDL levels and more increase in HDL levels, compared to those treated with products containing LNG (P = 0.001).
LIMITATIONS, REASONS FOR CAUTION
Considering this trial was conducted in women diagnosed with Androgen Excess Society criteria, the results may not be generalizable for mild phenotypes diagnosed using Rotterdam criteria. Other limitations of the study include the high dropout rate, the lack of a gold standard androgen assay and the multiple end points.
WIDER IMPLICATIONS OF THE FINDINGS
Our results support the views of clinicians, who suggest an OC with a low androgenic or antiandrogenic progestin, if available, to treat PCOS.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the RIES, Shahid Beheshti University of Medical Sciences, Tehran, Iran. There are no conflicts of interest.
TRIAL REGISTRATION NUMBER
IRCT201702071281N2.
TRIAL REGISTRATION DATE
21 February 2017.
DATE OF FIRST PATIENT’S ENROLMENT
21 March 2017.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>31916574</pmid><doi>10.1093/humrep/dez255</doi><tpages>12</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0268-1161 |
| ispartof | Human reproduction (Oxford), 2020-01, Vol.35 (1), p.175-186 |
| issn | 0268-1161 1460-2350 |
| language | eng |
| recordid | cdi_crossref_primary_10_1093_humrep_dez255 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Adolescent Adult Contraceptives, Oral Contraceptives, Oral, Combined - therapeutic use Female Humans Iran Levonorgestrel - therapeutic use Middle Aged Polycystic Ovary Syndrome - drug therapy Sex Hormone-Binding Globulin Young Adult |
| title | A comparison of the effects of oral contraceptives on the clinical and biochemical manifestations of polycystic ovary syndrome: a crossover randomized controlled trial |
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