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Effects of Oral Contraception and Lifestyle Modification on Incretins and TGF-ß Superfamily Hormones in PCOS.
Journal of Clinical Endocrinology and Metabolism 2020 September 25
OBJECTIVE: To examine effects of common treatments for PCOS on a panel of hormones(reproductive/metabolic).
DESIGN: Secondary analysis of blood from a RCT of three 16-week preconception interventions designed to improve PCOS-related abnormalities: continuous oral contraceptives(OCP, N=34 subjects), intensive lifestyle modification(Lifestyle, N =31) or combination of both(Combined, N=29).
MATERIALS AND METHODS: Post-treatment levels of activin A and B, inhibin B and follistatin as well as IGF-1, IGFBP-2, glucagon, GLP-1 and 2 and Oxyntomodulin were compared to baseline and change from baseline in these parameters were correlated with outcomes.
RESULTS: OCP use was associated with a significant suppression in activin A, inhibin A and AMH, but significant increase in follistatin. IGF-1, IGFBP-2, glucagon and GLP-2 levels were significantly decreased. Oxyntomodulin was profoundly suppressed by OCP[ratio of geometric means: 0.09, 95% CI(0.05, 0.18),p<.001]. None of the analytes were significantly affected by Lifestyle; whereas, effects of Combined were similar to OCP alone, although attenuated. Oxyntomodulin was significantly positively associated with change in total ovarian volume[rs = 0.27; 95% CI: (0.03, 0.48);p=0.03] and insulin sensitivity index[rs = 0.48; 95% CI: (0.27, 0.64);p<.001] and inversely correlated with change in AUC glucose[rs = -0.38; 95% CI: (-0.57, -0.16);p=0.001]. None of the hormonal changes were associated with live birth, only Activin A was associated with ovulation[risk ratio per 1 ng/mL increase in change in Activin A: 6.0(2.2, 16.2); p<.001].
CONCLUSIONS: In women with PCOS, OCP(and not Lifestyle) affects a wide variety of reproductive/metabolic hormones, but their treatment response does not correlate with live birth.
DESIGN: Secondary analysis of blood from a RCT of three 16-week preconception interventions designed to improve PCOS-related abnormalities: continuous oral contraceptives(OCP, N=34 subjects), intensive lifestyle modification(Lifestyle, N =31) or combination of both(Combined, N=29).
MATERIALS AND METHODS: Post-treatment levels of activin A and B, inhibin B and follistatin as well as IGF-1, IGFBP-2, glucagon, GLP-1 and 2 and Oxyntomodulin were compared to baseline and change from baseline in these parameters were correlated with outcomes.
RESULTS: OCP use was associated with a significant suppression in activin A, inhibin A and AMH, but significant increase in follistatin. IGF-1, IGFBP-2, glucagon and GLP-2 levels were significantly decreased. Oxyntomodulin was profoundly suppressed by OCP[ratio of geometric means: 0.09, 95% CI(0.05, 0.18),p<.001]. None of the analytes were significantly affected by Lifestyle; whereas, effects of Combined were similar to OCP alone, although attenuated. Oxyntomodulin was significantly positively associated with change in total ovarian volume[rs = 0.27; 95% CI: (0.03, 0.48);p=0.03] and insulin sensitivity index[rs = 0.48; 95% CI: (0.27, 0.64);p<.001] and inversely correlated with change in AUC glucose[rs = -0.38; 95% CI: (-0.57, -0.16);p=0.001]. None of the hormonal changes were associated with live birth, only Activin A was associated with ovulation[risk ratio per 1 ng/mL increase in change in Activin A: 6.0(2.2, 16.2); p<.001].
CONCLUSIONS: In women with PCOS, OCP(and not Lifestyle) affects a wide variety of reproductive/metabolic hormones, but their treatment response does not correlate with live birth.
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