Normalization of Testosterone Levels Using a Low Estrogen-containing Oral Contraceptive in Women with Polycystic Ovary Syndrome

Abstract

Polycystic ovary disease is usually associated with elevated blood androgen levels and varying degrees of hirsutism. The most commonly recommended treatment for hyperandrogenism is the administration of oral contraceptives. These have been associated with undesirable side effects because of their high estrogen content. Studies reported from the authors' laboratory, however, have shown that oral contraceptive compounds with a relatively low dose of estrogen and progestogens can increase testosterone-binding globulin and usually reduce the unbound testosterone level to normal. This report continues the previous studies and evaluates the effect of an oral contraceptive containing 30 μg of estrogen and a relatively large amount of progestogen (Loestrin 1.5/30) on androgen dynamics in patients with polycystic ovary syndrome. Twenty-five patients were included in the study. Table 1 shows serum levels of unbound testosterone and testosterone-binding globulin in untreated healthy women and in 25 women with polycystic ovary syndrome, before and after 12 to 16 weeks of treatment. Both serum and total testosterone and unbound testosterone levels were reduced to normal after treatment. The total and unbound testosterone levels were reduced in every patient treated. The testosterone-binding globulin level of those in the treated group increased, probably in response to the estrogen content of the contraceptive administered. Unbound testosterone concentration began to fall by the first week of treatment, reached the lowest point about 35 days after the start of treatment, and remained at that level throughout the entire study period. Serum LH levels fell in 19 patients and showed a slight increase in one. The mean serum LH levels, however, showed a lowering trend. All patients reported a decrease in hair growth, as indicated by decreased frequency of shaving, tweezing, or application of depilatories. Most patients reported a decrease in facial and scalp oiliness and an improvement in complexion. No significant changes were noted in blood pressure. Forty per cent of the patients (10 women) gained less than 2.3 kg, and 16 per cent (four women) gained more than 2.3 kg by 12 to 16 weeks of treatment. Eight per cent of the patients (two women) complained of breakthrough bleeding in the first month of treatment, but this has not recurred in subsequent periods. All patients complained of nausea in the first month of treatment. Four per cent (one patient) complained of headache, which was spontaneously resolved. The cystic ovaries previously palpated had regressed to normal size by 12 to 16 weeks of treatment with Loestrin.