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Spironolactone and intermenstrual bleeding in polycystic ovary syndrome with normal BMI

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Abstract

Purpose

Spironolactone (SP) is an effective treatment for polycystic ovary syndrome (PCOS), but it is often associated with menstrual abnormalities whose mechanism is still under investigation. In this study, we investigated the serum sex steroids and endometrial thickness in 30 PCOS patients, before and after one-month 100 mg SP treatment.

Methods

Serum FSH, LH, estradiol, progesterone and endometrial thickness were evaluated at the 14th and 16th day of the menstrual cycle, before and during short-term SP treatment. According to the presence (15 cases) or absence (15 cases) of menstrual bleeding at the 14th day during SP, the patients were divided into two groups, which were then compared using a two-tailed Student’s t test.

Results

Serum estradiol and endometrial thickness were lower than pretreatment at both determinations in all patients, but patients with bleeding had significantly lower estradiol values than non-bleeding ones, both before and after therapy. Endometrial thickness was significantly lower in the bleeding group compared with non-bleeding group only at the 16th day of the cycle. These differences were significant, even though the values of estradiol and endometrial thickness remained in the normal range.

Conclusions

SP therapy can reduce the values of estradiol and the endometrial thickness in patients with PCOS compared with pretreatment, but PCOS patients with bleeding had pretreatment estradiol values lower than the patients who did not complain of this side effect. Intermenstrual abnormalities may represent the low estrogen impregnation of endometrium due to SP, whose mechanism is complex, involving several factors, such as the effects of some metabolites of SP on estradiol and progesterone production, on their receptors, and the individual metabolism of SP in vivo.

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Acknowledgments

We acknowledge Ms. Sophie Armanini for English revision. Dr. Marta Zermiani is actually working in Barcelona.

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Authors and Affiliations

  1. Department of Medicine-Endocrinology, University of Padua, via Ospedale 105, 35128, Padua, Italy

    C. Sabbadin, M. Zermiani, M. Boscaro & D. Armanini

  2. Department of Women’s and Children’s Health, University of Padua, via Giustiniani 3, 35128, Padua, Italy

    A. Andrisani & G. Ambrosini

  3. Department of Molecular Medicine-Biological Chemistry, University of Padua, viale G. Colombo 3, 35131, Padua, Italy

    G. Donà & L. Bordin

  4. Department of Pharmaceutical and Pharmacological Sciences, University of Padua, via Marzolo 5, 35131, Padua, Italy

    E. Ragazzi

Authors
  1. C. Sabbadin
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  2. A. Andrisani
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  3. M. Zermiani
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  4. G. Donà
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  5. L. Bordin
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  6. E. Ragazzi
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  7. M. Boscaro
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  8. G. Ambrosini
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  9. D. Armanini
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Corresponding author

Correspondence to D. Armanini.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Sabbadin, C., Andrisani, A., Zermiani, M. et al. Spironolactone and intermenstrual bleeding in polycystic ovary syndrome with normal BMI. J Endocrinol Invest 39, 1015–1021 (2016). https://doi.org/10.1007/s40618-016-0466-0

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  • DOI: https://doi.org/10.1007/s40618-016-0466-0

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