Comparison of ovarian electrocautery and oral contraceptives in the treatment of hyperandrogenism in women with polycystic ovary syndrome.

BACKGROUND

Endocrine treatment of hyperandrogenism in women with polycystic ovary syndrome (PCOS) aims at reduction of androgens and increasing sex hormone binding globuline (SHBG), which are also side effects of ovarian electrocautery (OE) when used for induction of ovulation.

METHODS

Hormonal effects of ovarian electrocautery were compared with the effects of oral contraceptives (OC) containing desogestrel (DG) or cyproteron acetate (CPA). OCs were given to 18 women with PCOS as their sole treatment (group A) and to 23 women after the restoration of regular ovulatory cycling by ovarian electrocautery (group B).

RESULTS

Ovarian electrocautery induced ovulation and increased the concentration of estrogens and especially progesterone, while OC induced the opposite effects. In the androgens and SHBG the two treatments induced changes that were in the same direction, but OC treatment induced changes that exceeded those of OE. The concentration of SHBG increased from 27.9 to 127.7 nmol/L on OC treatment (Group A), compared with 37.2 to 44.9 after OE (Group B). The androgens decreased, for testosterone the decreases were 2.1 and 0.99 nmol/L, respectively, for androsterone 5.36 and 3 nmol/L, for dihydrotestosterone 0.12 and 0.1 nmol/L, and for DHEAS 3.28 and 1.8 umol/L. No further gain was obtained by the combination of the two treatments.

CONCLUSIONS

Hyperandrogenism in women with PCOS can be effectively treated with OCs containing DG or CPA. In women with concurrent infertility, however, ovarian electrocautery can be recommended. The only indication for the combination of these two treatments is ambivalence with regard to the fertility after ovulation induction by OE. A temporary delay of ovulatory cycling with OC-treatment after OE has no negative impact upon the future fertility.