Comparing the effects of letrozole and the effects of routine treatment of polycystic ovary syndrome in improving symptoms of hyperandrogenism

Alireza Mehdizadeh Khalifani; Neda Valizadeh; Afsaneh Fattazadeh; Reza Pourali

Alireza Mehdizadeh Khalifani Urmia University of Medical Sciences, Urmia, Iran
Neda Valizadeh Urmia University of Medical Sciences , Urmia, Iran
Afsaneh Fattazadeh Urmia University of Medical Sciences and Health Services, Urmia, Iran
Reza Pourali Urmia University of Medical Sciences and Health Services, Urmia, Iran

Keywords: Letrozole, polycystic ovary syndrome, metformin, cyproterone acetate, oral Ethinylestradiol

Abstract

Polycystic ovary syndrome (PCOS) is one of the common forms of chronic anovulation associated with an increase in androgens. This disorder is associated with important morbidities during reproductive years. The objective of this research was to compare the effects of letrozole and routine treatment (oral Ethinylestradiol, cyproterone acetate and metformin) of polycystic ovary syndrome in improving symptoms of hyperandrogenism (hirsutism, acne).
This is an applied-experimental study in which, 80 patients diagnosed with PCOS (polycystic ovary syndrome) were randomly divided into two groups. The first group was treated with 2.5 mg of Letrozole daily and the second group was treated with 500 mg of metformin once per day, 100 mg of cyproterone acetate once per day since 5-15 days of menstruation and oral Ethinylestradiol daily since 5 -25 days of menstrual cycles and they were followed-up regularly and periodically in the endocrinology clinic. After collecting data, they were analyzed using spss Software.

No significant difference was found between two groups in the improvement of the hirsutism (p = 0.27). No significant difference was found between two groups in the improvement of acne (p = 0.54). In addition, the results of this study did not show any significant difference between the two groups in terms of acne and hirsutism improvement in the 6-month follow up.
Based on the results of this study, two groups did not differ significantly. However, given the reduction in Ferriman-Gallwey score, letrozole can be a suitable drug for treating the symptoms of hyperandrogenism. Extensive studies are required in this regard to prove this assumption.

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Author Biographies

Alireza Mehdizadeh Khalifani, Urmia University of Medical Sciences, Urmia, Iran

Internal Specialist, Endocrinology & Metabolism Specialist, Assistant Professor, Urmia University of Medical Sciences, Urmia, Iran

Neda Valizadeh, Urmia University of Medical Sciences , Urmia, Iran

Internal Specialist, Endocrinology & Metabolism Specialist, Assistant Professor of Urmia University of Medical Sciences , Urmia, Iran

Afsaneh Fattazadeh, Urmia University of Medical Sciences and Health Services, Urmia, Iran

Urmia University of Medical Sciences and Health Services, Urmia, Iran

Reza Pourali, Urmia University of Medical Sciences and Health Services, Urmia, Iran

Urmia University of Medical Sciences and Health Services, Urmia, Iran

References

Atay, V., Cam, C., Muhcu, M., Cam, M., & Karateke, A. (2006). Comparison of letrozole and clomiphene citrate in women with polycystic ovaries undergoing ovarian stimulation. Journal of international medical research, 34(1), 73-76.

Balasubramanian, R., Dwyer, A., Seminara, S. B., Pitteloud, N., Kaiser, U. B., & Crowley Jr, W. F. (2010). Human GnRH deficiency: a unique disease model to unravel the ontogeny of GnRH neurons. Neuroendocrinology, 92(2), 81-99.

Boivin, J., Bunting, L., Collins, J. A., & Nygren, K. G. (2007). International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Human reproduction, 22(6), 1506-1512.

Bozdag, G., Mumusoglu, S., Zengin, D., Karabulut, E., & Yildiz, B. O. (2016). The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction, 31(12), 2841- 2855.

Craigle, V. (2007). MedWatch: the FDA safety information and adverse event reporting program. Journal of the Medical Library Association, 95(2), 224.

Dăneasă, A., Cucolaş, C., Lenghel, L. M., Olteanu, D., Orăsan, R., & Filip, G. A. (2016). Letrozole vs estradiol valerate induced PCOS in rats: glycemic, oxidative and inflammatory status assessment. Reproduction, 151(4), 401-409.

Duleba, A. J., & Dokras, A. (2012). Is PCOS an inflammatory process? Fertility and sterility, 97(1), 7-12.

Escobar-Morreale, H. F., Carmina, E., Dewailly, D., Gambineri, A., Kelestimur, F., Moghetti, P., ... & Norman, R. J. (2011). Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Human reproduction update, 18(2), 146-170.

Farr, S., Folger, S. G., Paulen, M., Tepper, N., Whiteman, M., Zapata, L., ... & Cansino, C. (2010). U S. medical eligibility criteria for contraceptive use, 2010: adapted from the World Health Organization medical eligibility criteria for contraceptive use. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports/Centers for Disease Control, 59(RR-4), 1-86.

Franik, S., Kremer, J. A., Nelen, W. L., Farquhar, C., & Marjoribanks, J. (2015). Aromatase inhibitors for subfertile women with polycystic ovary syndrome: summary of a Cochrane review. Fertility and sterility, 103(2), 353-355.

Gifford, J. H. (2015). The role of WNT signaling in adult ovarian folliculogenesis. Reproduction, 150(4), R137- R148.

Hart, R., & Doherty, D. A. (2015). The potential implications of a PCOS diagnosis on a woman’s long-term health using data linkage. The Journal of Clinical Endocrinology & Metabolism, 100(3), 911-919.

Joshi, B., Mukherjee, S., Patil, A., Purandare, A., Chauhan, S., & Vaidya, R. (2014). A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India. Indian journal of endocrinology and metabolism, 18(3), 317.

Kamangar, F., Okhovat, J. P., Schmidt, T., Beshay, A., Pasch, L., Cedars, M. I. ... & Shinkai, K. (2015). Polycystic ovary syndrome: special diagnostic and therapeutic considerations for children. Pediatric dermatology, 32(5), 571-578.

Lee, Y., Yang, H., Lee, S., Kwon, S., Hong, E. J., & Lee, H. (2018). Welsh onion root (Allium fistulosum) restores ovarian functions from letrozole induced-polycystic ovary syndrome. Nutrients, 10(10), 1430.

Longo, D. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Jameson, J. L., & Loscalzo, J. (2012). Harrison's principles of internal medicine 18E Vol 2 EB. McGraw Hill Professional.

Mahran, A., Abdelmeged, A., Shawki, H., Moheyelden, A., & Ahmed, A. M. (2016). Nitric oxide donors improve the ovulation and pregnancy rates in anovulatory women with polycystic ovary syndrome treated with clomiphene citrate: A RCT. International Journal of Reproductive BioMedicine, 14(1), 9.

Mehdinejadiani, S., Amidi, F., Mehdizadeh, M., Barati, M., Pazhohan, A., Alyasin, A. ... & Sobhani, A. (2018). Effects of letrozole and clomiphene citrate on Wnt signaling pathway in endometrium of polycystic ovarian syndrome and healthy women. Biology of reproduction.

Mehdinejadiani, S., Amidi, F., Mehdizadeh, M., Barati, M., Safdarian, L., Aflatoonian, R. ... & Mohammadzadeh kazorgah, F. (2018). The effects of letrozole and clomiphene citrate on ligands expression of Wnt3, Wnt7a, and Wnt8b in proliferative endometrium of women with polycystic ovarian syndrome. Gynecological Endocrinology, 1-6.

Roy, K. K., Baruah, J., Singla, S., Sharma, J. B., Singh, N., Jain, S. K., & Goyal, M. (2012). A prospective randomized trial comparing the efficacy of Letrozole and Clomiphene citrate in induction of ovulation in polycystic ovarian syndrome. Journal of human reproductive sciences, 5(1), 20.

Saha, L., Kaur, S., & Saha, P. K. (2012). Pharmacotherapy of polycystic ovary syndrome– an update. Fundamental & clinical pharmacology, 26(1), 54-62.

Sylus, A. M., Nandeesha, H., Sridhar, M. G., Chitra, T., & Sreenivasulu, K. (2018). Clomiphene Citrate increases Nitric oxide, Interleukin-10 and reduces Matrix metalloproteinase-9 in women with Polycystic Ovary Syndrome. European Journal of Obstetrics & Gynecology and Reproductive Biology.