RESUMO
Polycystic disease of the ovary is complex of symptoms with virious clinical, hormonal and biochemical abnormalities. AL-Elwyia Maternity Teaching Hospital To test the ability of pioglitazone in correcting biochemical and hormonal changes among unmarried women with PCO. Prospective. 23 women with PCO in whom previous treatment with metformin has failed were recruited to participate in the study. All the women were single with chronic unovulation and menstrual abnormalities and hirsutism. They "were put on pioglitazone 30 mg daily for 6 months. FSH, LH, LH/ FSH, fasting insulin level, free testosterone, estradiol, and serum sex binding globulin as well as mid luteal progesterone were assessed prior to treatment and six months later. There was significant reduction in the mean serum fasting insulin level [53.08+12. 75 vs. 22.43+4.29: P< 0.001]. In addition there was significant reduction in the mean serum free testosterone, LH and LH/ FSH ratio [3.21 + 0.36 vs. 1.68+0.43: P<0.001], [15.19+4.43 vs. 10.72+3.08: P<0.001], [2.41+0.23 vs. 1.71+0.12: P<0.001] respectively. In addition mean serum progesterone at mid luteal phase increased significantly [2.44+1.11 vs. 18.61+2.28: P<0.001]. No woman during the treatment course has shown any sign of liver impairment or toxicity. Pioglitazone is an insulin sensitizing drug which may be useful among women with PCO in whom previous treatment with metformin has failed. Yet, caution should be practiced in prescribing the drug until further studies confirm its safety and efficacy
RESUMO
Danazol is a synthetic steroid primarily used to treat endometriosis. Its effectiveness is due to the reversible hypooestrogenic and hyper-androgenic state which leads to atrophy of endometrial tissue. Its effect on cervical tissue has not yet been studied. Pap smear is a well known method for cyto-morphological evaluation of exfoliated or mechanically dislodged cervical cells. It can detect pathologic abnormalities as well as hormonal effects. An attempt to link prolonged danazol therapy [leading to relief of symptoms of endometriosis] to changes in cervical cytology during this therapy and trying to find a possible relationship between them was tile main goal of this study. To study cervical cytological changes with continuous oral danazol use A Prospective Study done in AI-Elwiya Maternity Teaching Hospital and Central Health Laboratory/ Baghdad, Iraq; wherein sixty eight cases of pelvic endometriosis with primary infertility, started oral danazol between January 2002 and November 2002, in doses of 200-800mg/day. Their ages were between 20-38years. The forty cases included in this study had the following criteria collectively: [a] Cases with primary infertility and endometriosis irrespective to their age or stage of the disease [b] Normal cervical cytology prior to commencement of treatment [c] Amenorrhea and symptom free. During the period of treatment [d] Use of barrier method of contraception [condom]. [e] Monthly performed high vaginal swab revealed normal flora and [f] No biochemical evidence of impaired glucose metabolism. According to the American Fertility Society Score [AFSS], 16 cases had stage II, 20 cases had stage III, and 4 cases had stage IV. None had stage I. Cervical cytology was repeated after nine months continuous oral danazol treatment. The forty cases that fit the criteria of inclusion were divided into two groups; A and B; group B included the 12 cases requiring equal to or less than 400mg/day oral danazol while group A included the twenty eight cases that required more than 400mg/day danazol. After the completion of nine months treatment, group B showed cervical cytological changes of "squamous metaplasia", while group A showed "androgenic" picture of cervical cytology i.e. proliferation of glycogen rich intermediate cells with vesicular nuclei. Cervical cytology changes can be caused by continuous nine month oral danazol therapy if we want to reach a symptom free state in patients with primary infertility and endometriosis. These changes were dose related, when the dose exceeded 400mg/day, the changes were mainly androgenic, while doses equal to or less than 400mg/day showed sqamous metaplasia. The changes were irrespective to age and stage of the disease