Comparison of four different treatment regimens on coagulation parameters, hormonal and metabolic changes in women with polycystic ovary syndrome

To determine the effects of different treatment regimens on the hormonal features, metabolic parameters, and hematologic variables in women with polycystic ovary syndrome (PCOS). Forty-eight women with PCOS were randomized into four treatment protocols: ethinyl estradiol/cyproterone acetate (EE/CA; n = 12), EE/CA-metformin (n = 12), metformin alone (n = 12) and EE/CA-spironolactone (n = 12). These treatment protocols were given for 3 months and pre- and post-treatment variables were compared. Activated partial thromboplastin time (APTT) and prothrombin time (PT) levels, D-dimer, HOMA-IR, insulin, WBC, MPV as well as androgen levels decreased in all treatment groups. EE/CA-metformin and metformin alone groups resulted in a higher proportional reduction of D-dimer levels than the other protocols, while no significant different proportional reduction was observed in all the four groups for MPV, WBC, APTT, PT values. EE/CA-metformin group showed higher proportional reduction fasting insulin concentrations, HOMA-IR and free testosterone levels than metformin alone and EE/CA-spironolactone groups. DHEAs levels significantly decreased in group EE/CA-metformin than EE/CA alone and EE/CA-spironolactone groups. In multiple stepwise regression analyses, reduction in proportional insulin levels was independently and positively associated with decrease of MPV, D-dimer, free testosterone levels. In all treatment groups, we observed reduced levels of coagulation parameters, improvement of hormonal, hematological and metabolical variables by most probably reducing insulin levels. Among the treatment groups, EE/CA-metformin may be a more effective therapeutic option than the other protocols and this may be due to the beneficial effect of EE/CA-metformin on insulin resistance.