163 Journal of Family Planning and Reproductive Health Care 2004: 30(3) Abstract Background Polycystic ovary syndrome (PCOS) is the commonest endocrine disturbance affecting women in the reproductive age group and encompasses signs of hyperandrogenism, menstrual cycle disturbances and obesity. Some of the symptoms of PCOS may be ameliorated by the combined oral contraceptive pill (COCP). Methods A pilot observational study was carried out in a university teaching hospital setting to determine whether the clinical and biochemical features of PCOS are ameliorated by a new COCP, Yasmin ® , which contains a new progestogen, drosperinone. Treatment with Yasmin was given for 6 months to 17 patients. Results Thirteen patients (76%) completed 6 months of therapy. Good cycle control was achieved in all patients. Percentage body fat increased, with no overall change in body mass index. Fasting insulin and triglyceride concentrations rose significantly. Serum total testosterone concentrations fell with a concomitant rise in sex hormone binding globulin levels. Hirsutism scores did not change significantly in the 12 women who were clinically hirsute. There was, however, a significant improvement in the acne scores. Four of the 17 patients dropped out of the trial between Cycles 3 and 5 due to side effects. Conclusions Yasmin provides good cycle control for women with PCOS, with an improvement in acne over 6 months but not in other symptoms of the syndrome. Key message points ● Yasmin provides control of the menstrual cycle in women with polycystic ovary syndrome (PCOS). ● Acne improves, and hirsutism and BMI do not change, in women prescribed Yasmin for PCOS. Introduction Polycystic ovary syndrome (PCOS) is the most common endocrine disturbance affecting women of reproductive age. 1 Estimates of the presence of PCOS in the general population range from 15% to 25% 2,3 in Caucasians and are as high as 52% in Asians in the UK. 4 The features of PCOS include menstrual irregularities, infertility, hyperandrogenism (acne, hirsutism), obesity and the metabolic features of insulin resistance. 1 All symptoms are aggravated by an increase in body weight. 5 Management of the symptoms of PCOS is orientated to the individual’s symptoms, which may change over time. Young women with menstrual irregularity and hyperandrogenism have traditionally been treated with the combined oral contraceptive pill (COCP). 6 A frequently prescribed preparation is Dianette ® (Schering Healthcare Ltd, Burgess Hill, UK), which contains ethinyl oestradiol 35 µg and the anti-androgen, cyproterone acetate 2 mg. Other medical treatments of the cutaneous aspects of PCOS include cyproterone acetate alone, spironolactone, flutamide and finasteride, but all take at least 3–6 months before an improvement is seen and may be associated with potentially toxic and adverse metabolic effects. A new combined oral contraceptive, Yasmin ® (Schering Healthcare Ltd), has recently been developed, containing ethinyl oestradiol 30 mg and a new progestogen drospirenone (3 mg). Drospirenone is derived from 17-α- spironolactone, unlike most other current progestogens that are derived from 19-nortestosterone and therefore may have androgenic effects. Several studies have shown that drospirenone has a similar pharmacological profile to that of natural progesterone with clinically relevant anti- mineralocorticoid and anti-androgenic effects. 7–10 We performed a pilot observational study to determine whether the clinical and biochemical features of PCOS are ameliorated by Yasmin. Methods Patients with PCOS were recruited from the gynaecology clinic in a university teaching hospital setting. PCOS was defined as the presence of polycystic ovaries on ultrasound combined with at least one of the following symptoms: irregular menstrual cycles, hirsutism, acne, elevated serum concentrations of luteinising hormone and testosterone. 1 Patients were selected on the basis of their willingness and suitability to be treated with a COCP. Exclusion criteria were obesity [body mass index (BMI) >35 kg/m 2 ], heavy smokers (>10 cigarettes/day) and other contraindications to oral contraceptive use. Local research ethics committee approval was obtained prior to commencing the study and all patients gave written consent. Treatment continued for 6 months and patients were assessed at baseline and after 1, 3 and 6 months. BMI was calculated as kilograms per square metre (kg/m 2 ). Waist:hip ratio was calculated from waist circumference at the level of the umbilicus and maximal hip circumference. Body fat was measured by the method of Durnin and Womersley. 11 The coefficient of variation (CV) was 6%. Blood pressure was measured with the subjects seated after a period of 15 minutes’ rest. Hirsutism was scored by the Ferriman and Gallwey score, with a CV of 4.2%. 12 Acne scores were scored on an arbitrary scale of 0–3 (0 = no symptoms, 1 = mild, 2 = moderate, 3 = severe). The ovarian morphology was assessed at Time 0 and 6 months by transvaginal ultrasound (HDI 3000, ATL ORIGINAL ARTICLE An observational study of Yasmin ® in the management of women with polycystic ovary syndrome Manisha Palep-Singh, MRCOG, DNBE, Research Fellow in Reproductive Medicine, Department of Reproductive Medicine; Karen Mook, Research Nurse in Reproductive Medicine, Department of Reproductive Medicine; Julian Barth, MD, FRCPath, Consultant Chemical Pathologist, Department of Clinical Biochemistry; Adam Balen, MD, FRCOG, Consultant Gynaecologist and Subspecialist in Reproductive Medicine, Department of Reproductive Medicine, Leeds General Infirmary, Leeds, UK Correspondence: Mr Adam Balen, Department of Reproductive Medicine, Clarendon Wing, Level C, Leeds General Infirmary, Leeds LS2 9NS, UK. Tel: +44 (0) 113 392 2728. Fax: +44 (0) 113 392 2446. E-mail: adam.balen@leedsth.nhs.uk (Accepted 3rd March 2004) Journal of Family Planning and Reproductive Health Care 2004; 30(3): 163–165