human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Polycystic ovary syndrome ( PCOS ) presents in adolescence , and obesity is a common finding . The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear . OBJECTIVE We investigated the effects of metformin , oral contraceptives ( OCs ) , and /or lifestyle modification in obese adolescent women with PCOS . DESIGN Two small , r and omized , placebo-controlled clinical trials were performed . PATIENTS AND PARTICIPANTS A total of 79 obese adolescent women with PCOS participated . INTERVENTIONS In the single treatment trial , subjects were r and omized to metformin , placebo , a lifestyle modification program , or OC . In the combined treatment trial , all subjects received lifestyle modification and OC and were r and omized to metformin or placebo . MAIN OUTCOME MEASURES Serum concentrations of and rogens and lipids were measured . RESULTS Lifestyle modification alone result ed in a 59 % reduction in free and rogen index with a 122 % increase in SHBG . OC result ed in a significant decrease in total testosterone ( 44 % ) and free and rogen index ( 86 % ) but also result ed in an increase in C-reactive protein ( 39.7 % ) and cholesterol ( 14 % ) . The combination of lifestyle modification , OC , and metformin result ed in a 55 % decrease in total testosterone , as compared to 33 % with combined treatment and placebo , a 4 % reduction in waist circumference , and a significant increase in HDL ( 46 % ) . CONCLUSIONS In these preliminary trials , both lifestyle modification and OCs significantly reduce and rogens and increase SHBG in obese adolescents with PCOS . Metformin , in combination with lifestyle modification and OC , reduces central adiposity , reduces total testosterone , and increases HDL , but does not enhance overall weight reduction Objective Women with polycystic ovary syndrome ( PCOS ) have multiple risk factors for cardiovascular disease . The cardiovascular risk marker homocysteine ( Hcy ) is elevated in women with PCOS . This prospect i ve study investigated the effect of oral contraceptives containing ethinyl estradiol – cyproterone acetate ( EE – CA ) on serum Hcy levels in women with PCOS . Study design A total of 30 women with PCOS were enrolled in this prospect i ve study . The diagnosis of PCOS was made according to the criteria of the Rotterdam PCOS consensus workshop group . All women  took oral contraceptives containing EE/CA ( 35 μg/2 mg ) for 3 months . Serum sample s for Hcy , lipid profile and hormones were obtained during the early follicular phase ( days 3–5 ) of the spontaneous or progestin-induced bleeding at baseline , and after the third treatment cycle . Results Three months of EE – CA therapy significantly decreased the Hcy levels from 55.97 ± 16.04 to 54.03 ± 16.15 ( P = 0.01 ) . A significant correlation was observed between the Hcy and total and free testosterone levels ( r = 0.44 , P = 0.015 and r = 0.46 , P = 0.001 respectively ) . Conclusions Although the decrease in Hcy levels with EE – CA therapy was statistically significant , further studies are necessary to determine the clinical benefit of this treatment Hirsutism is a common and distressing symptom frequently encountered in women with polycystic ovary syndrome ( PCOS ) , who also show relative insulin resistance . The aim of this trial , in which hirsutism was the primary end point , was to compare the efficacy of the oral antihyperglycemic medication metformin with that of an established treatment , combined ethinyl estradiol and cyproterone acetate .  Patients ( n = 52 ) were r and omized to receive either metformin ( 500 mg , three times daily ) or Dianette ( ethinyl estradiol , 35 micro g ; cyproterone acetate , 2 mg ) treatment for 12 months , with assessment s before treatment , at 6 months , and at 12 months . Both objective and subjective methods of evaluating hirsutism were used , and in addition , patient perceptions were examined . The results show that metformin is potentially an effective treatment for moderate to severe hirsutism in women with PCOS . They also suggest that in some respects ( Ferriman-Gallwey score and patient self- assessment ) , it is more efficacious than the st and ard treatment ( Dianette ) . The objective evaluation of hair diameter reduction showed that both treatments were moderately effective at multiple anatomical sites . Dianette treatment was responsible for profound suppression of and rogen activity , in contrast to metformin , which induced negligible change . However , metformin did reduce markers of insulin resistance . The data suggest that hirsutism may be effectively treated by reducing hyperinsulinemia BACKGROUND Neither oral contraceptives ( COC ) nor metformin are an optimal modality for the long-term treatment of polycystic ovary syndrome ( PCOS ) . The aim of this study was to evaluate whether a combination of both is beneficial over COC monotherapy . METHODS Altogether , 30 women were included in the study and 28 finished the protocol . The patients were r and omly assigned to two groups treated with either COC ( COC group ) or COC and metformin ( 1500 mg/day ) ( METOC group ) for 6 months . Anthropometric parameters , and rogens , lipids , fasting insulin , glucose and sex hormone binding globulin ( SHBG ) concentrations were measured before and at the end of the sixth cycle of treatment . The insulin sensitivity index was evaluated using the euglycaemic clamp . RESULTS There were no significant changes in anthropometric parameters , fasting glucose or insulin sensitivity in either group . Total testosterone , free and rogen index , and rostenedione and dehydroepi and rosterone decreased and SHBG increased significantly in both groups . When comparing the effect of both treatments , only a more pronounced decrease in free and rogen index was found in the METOC group . CONCLUSIONS Adding metformin slightly modified the treatment effect of COC , causing a more significant decrease in the free and rogen index but having no additional positive impact on lipids , insulin sensitivity , SHBG or testosterone . The available data do not offer enough evidence to advocate the st and ard use of combined treatment in PCOS . Whether the combination might be beneficial for specific subgroups of patients is of further interest OBJECTIVE To compare the effects of cyproterone acetate and desogestrel , as part of combined oral contraceptives , on lipid metabolism and  hirsutism of adolescents with polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve r and omized clinical trial . SETTING Outpatient gynecology clinic ( referral center ) of a university . PATIENT(S ) Twenty-eight adolescent girls with clinical and biological hyper and rogenism and six or less menses during the past 12 months . INTERVENTION(S ) Group A ( n = 14 ) received 0.15 mg of desogestrel plus 0.030 mg of ethinyl estradiol daily . Group B ( n = 14 ) received 2 mg of cyproterone acetate plus 0.035 mg of ethinyl estradiol daily . Treatment was given for 21 days followed by a 7-day rest for a period of 12 months . MAIN OUTCOME MEASURE(S ) Hirsutism and lipid profile were evaluated before initiation and at 3 , 6 , 9 , and 12 months of treatment . And rogen profile was evaluated before and at 12 months of treatment . RESULT ( S ) A significant decline of the Ferriman-Gallway hirsutism score was observed from the sixth month of therapy in both groups . During therapy , the levels of testosterone , free testosterone , Delta(4)- and rostenedione , and 17OH-progesterone decreased significantly , whereas sex hormone-binding globulin ( SHBG ) increased significantly in both groups . The level of total cholesterol and low density lipoprotein ( LDL ) cholesterol increased significantly , whereas high density lipoprotein ( HDL ) cholesterol and apolipoprotein A-I increased significantly from the third month of therapy in both groups . Total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios remained unchanged . The levels of triglycerides increased significantly in the cyproterone acetate-treated group after the third month . CONCLUSION ( S ) Treatment of adolescent girls with PCOS with the two studied formulations is comparably effective in decreasing hirsutism and and rogen levels . Both combined oral contraceptives are associated with an increase of total cholesterol , LDL cholesterol , and HDL cholesterol levels and no change of the total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios . Treatment with the cyproterone acetate combined oral contraceptive is associated with a tendency toward increasing the levels of triglycerides OBJECTIVE To test the hypothesis that statins improve hyper and rogenemia in women with polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve , r and omized trial . SETTING Academic medical center . PATIENT(S ) Forty-eight women with PCOS . INTERVENTION(S ) Subjects were r and omized to a statin group ( simvastatin , 20 mg daily plus oral contraceptive pill [ OCP ] ; n = 24 ) or an OCP group ( OCP alone ; n = 24 ) . MAIN OUTCOME MEASURE(S ) Serum T. RESULT ( S ) Baseline parameters of both groups were comparable . After 12 weeks of treatment , serum T levels declined by 41 % in the statin group and by 14 % in the OCP group . In the statin group , there was a greater decrease of LH ( 43 % decrease vs. 9 % in the OCP group ) and a greater decline of LH/FSH ratio ( 44 % vs. 12 % ) . In the statin group , total cholesterol declined by 10 % and low-density lipoprotein ( LDL ) by 24 % . In the OCP group , total cholesterol increased by 8 % , and LDL was unchanged . CONCLUSION ( S ) This is the first study demonstrating that statin decreases T levels and normalizes gonadotropin levels in women with PCOS . Statin therapy might offer a novel approach , providing endocrine and cardiovascular benefits The present study was design ed in order to : ( a ) compare ET-1 and ADMA levels , between women with PCOS ( n=106 ) and healthy controls ( n=30 ) ; ( b ) determine the effects of treatment with estrogens and anti- and rogens on the hormonal features of PCOS , insulin resistance , ET-1 and ADMA levels . Women with PCOS were r and omized in five therapeutic protocol s : ( I ) 17beta-estradiol+cyproterone acetate 50 mg ; ( II ) conjugated estrogen+CA 50 mg ; ( III ) ethinyl estradiole+CA 2 mg ; ( IV ) EE+CA 52 mg ; ( V ) EE+desogestrel . In all women , gonadotropin , PRL , and rogen , SHBG , insulin , glucose , ET-1 and ADMA levels were determined ; in women with PCOS , testosterone , SHBG , ET-1 and ADMA levels were measured again after 3 , 6 , 12 months of treatment and insulin and glucose levels after 12 months . ET-1 and ADMA concentrations were higher in women with PCOS , and they were positively correlated with each other . ADMA levels were decreased and IR was increased with treatment . Treatment with synthetic estrogens ( EE ) result ed in a more pronounced increase in SHBG and a more pronounced decrease in FAI , compared to natural estrogens . Conclusively , PCOS is associated with endothelial dysfunction , which is ameliorated by the administration of estrogens and anti- and rogens , independent of IR OBJECTIVE To assess the interaction between insulin resistance and endothelial function and the optimal treatment strategy addressing cardiovascular risk in polycystic ovary syndrome . DESIGN R and omized controlled trial . SETTING Controlled clinical study . PATIENT(S ) Overweight age- and body mass index-matched women with polycystic ovary syndrome . INTERVENTION(S ) Six months metformin ( 1 g two times per day , n = 36 ) or oral contraceptive pill ( OCP ) ( 35 microg ethinyl E(2)-2 mg cytoproterone acetate , n = 30 ) . MAIN OUTCOME MEASURE(S ) Fasting and oral glucose tolerance test glucose and insulin levels , endothelial function ( flow-mediated dilation , asymmetric dimethylarginine , plasminogen activator inhibitor-1 , von Willebr and factor ) , inflammatory markers ( high-sensitivity C-reactive protein ) , lipids , and hyper and rogenism . RESULT ( S ) The OCP increased levels of glucose and insulin on oral glucose tolerance test , high-sensitivity C-reactive protein , triglycerides , and sex-hormone binding globulin and decreased levels of low-density lipoprotein cholesterol and T.  Metformin decreased levels of fasting insulin , oral glucose 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Polycystic ovary syndrome ( PCOS ) presents in adolescence , and obesity is a common finding . The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear . OBJECTIVE We investigated the effects of metformin , oral contraceptives ( OCs ) , and /or lifestyle modification in obese adolescent women with PCOS . DESIGN Two small , r and omized , placebo-controlled clinical trials were performed . PATIENTS AND PARTICIPANTS A total of 79 obese adolescent women with PCOS participated . INTERVENTIONS In the single treatment trial , subjects were r and omized to metformin , placebo , a lifestyle modification program , or OC . In the combined treatment trial , all subjects received lifestyle modification and OC and were r and omized to metformin or placebo . MAIN OUTCOME MEASURES Serum concentrations of and rogens and lipids were measured . RESULTS Lifestyle modification alone result ed in a 59 % reduction in free and rogen index with a 122 % increase in SHBG . OC result ed in a significant decrease in total testosterone ( 44 % ) and free and rogen index ( 86 % ) but also result ed in an increase in C-reactive protein ( 39.7 % ) and cholesterol ( 14 % ) . The combination of lifestyle modification , OC , and metformin result ed in a 55 % decrease in total testosterone , as compared to 33 % with combined treatment and placebo , a 4 % reduction in waist circumference , and a significant increase in HDL ( 46 % ) . CONCLUSIONS In these preliminary trials , both lifestyle modification and OCs significantly reduce and rogens and increase SHBG in obese adolescents with PCOS . Metformin , in combination with lifestyle modification and OC , reduces central adiposity , reduces total testosterone , and increases HDL , but does not enhance overall weight reduction Objective Women with polycystic ovary syndrome ( PCOS ) have multiple risk factors for cardiovascular disease . The cardiovascular risk marker homocysteine ( Hcy ) is elevated in women with PCOS . This prospect i ve study investigated the effect of oral contraceptives containing ethinyl estradiol – cyproterone acetate ( EE – CA ) on serum Hcy levels in women with PCOS . Study design A total of 30 women with PCOS were enrolled in this prospect i ve study . The diagnosis of PCOS was made according to the criteria of the Rotterdam PCOS consensus workshop group . All women  took oral contraceptives containing EE/CA ( 35 μg/2 mg ) for 3 months . Serum sample s for Hcy , lipid profile and hormones were obtained during the early follicular phase ( days 3–5 ) of the spontaneous or progestin-induced bleeding at baseline , and after the third treatment cycle . Results Three months of EE – CA therapy significantly decreased the Hcy levels from 55.97 ± 16.04 to 54.03 ± 16.15 ( P = 0.01 ) . A significant correlation was observed between the Hcy and total and free testosterone levels ( r = 0.44 , P = 0.015 and r = 0.46 , P = 0.001 respectively ) . Conclusions Although the decrease in Hcy levels with EE – CA therapy was statistically significant , further studies are necessary to determine the clinical benefit of this treatment Hirsutism is a common and distressing symptom frequently encountered in women with polycystic ovary syndrome ( PCOS ) , who also show relative insulin resistance . The aim of this trial , in which hirsutism was the primary end point , was to compare the efficacy of the oral antihyperglycemic medication metformin with that of an established treatment , combined ethinyl estradiol and cyproterone acetate .  Patients ( n = 52 ) were r and omized to receive either metformin ( 500 mg , three times daily ) or Dianette ( ethinyl estradiol , 35 micro g ; cyproterone acetate , 2 mg ) treatment for 12 months , with assessment s before treatment , at 6 months , and at 12 months . Both objective and subjective methods of evaluating hirsutism were used , and in addition , patient perceptions were examined . The results show that metformin is potentially an effective treatment for moderate to severe hirsutism in women with PCOS . They also suggest that in some respects ( Ferriman-Gallwey score and patient self- assessment ) , it is more efficacious than the st and ard treatment ( Dianette ) . The objective evaluation of hair diameter reduction showed that both treatments were moderately effective at multiple anatomical sites . Dianette treatment was responsible for profound suppression of and rogen activity , in contrast to metformin , which induced negligible change . However , metformin did reduce markers of insulin resistance . The data suggest that hirsutism may be effectively treated by reducing hyperinsulinemia BACKGROUND Neither oral contraceptives ( COC ) nor metformin are an optimal modality for the long-term treatment of polycystic ovary syndrome ( PCOS ) . The aim of this study was to evaluate whether a combination of both is beneficial over COC monotherapy . METHODS Altogether , 30 women were included in the study and 28 finished the protocol . The patients were r and omly assigned to two groups treated with either COC ( COC group ) or COC and metformin ( 1500 mg/day ) ( METOC group ) for 6 months . Anthropometric parameters , and rogens , lipids , fasting insulin , glucose and sex hormone binding globulin ( SHBG ) concentrations were measured before and at the end of the sixth cycle of treatment . The insulin sensitivity index was evaluated using the euglycaemic clamp . RESULTS There were no significant changes in anthropometric parameters , fasting glucose or insulin sensitivity in either group . Total testosterone , free and rogen index , and rostenedione and dehydroepi and rosterone decreased and SHBG increased significantly in both groups . When comparing the effect of both treatments , only a more pronounced decrease in free and rogen index was found in the METOC group . CONCLUSIONS Adding metformin slightly modified the treatment effect of COC , causing a more significant decrease in the free and rogen index but having no additional positive impact on lipids , insulin sensitivity , SHBG or testosterone . The available data do not offer enough evidence to advocate the st and ard use of combined treatment in PCOS . Whether the combination might be beneficial for specific subgroups of patients is of further interest OBJECTIVE To compare the effects of cyproterone acetate and desogestrel , as part of combined oral contraceptives , on lipid metabolism and  hirsutism of adolescents with polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve r and omized clinical trial . SETTING Outpatient gynecology clinic ( referral center ) of a university . PATIENT(S ) Twenty-eight adolescent girls with clinical and biological hyper and rogenism and six or less menses during the past 12 months . INTERVENTION(S ) Group A ( n = 14 ) received 0.15 mg of desogestrel plus 0.030 mg of ethinyl estradiol daily . Group B ( n = 14 ) received 2 mg of cyproterone acetate plus 0.035 mg of ethinyl estradiol daily . Treatment was given for 21 days followed by a 7-day rest for a period of 12 months . MAIN OUTCOME MEASURE(S ) Hirsutism and lipid profile were evaluated before initiation and at 3 , 6 , 9 , and 12 months of treatment . And rogen profile was evaluated before and at 12 months of treatment . RESULT ( S ) A significant decline of the Ferriman-Gallway hirsutism score was observed from the sixth month of therapy in both groups . During therapy , the levels of testosterone , free testosterone , Delta(4)- and rostenedione , and 17OH-progesterone decreased significantly , whereas sex hormone-binding globulin ( SHBG ) increased significantly in both groups . The level of total cholesterol and low density lipoprotein ( LDL ) cholesterol increased significantly , whereas high density lipoprotein ( HDL ) cholesterol and apolipoprotein A-I increased significantly from the third month of therapy in both groups . Total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios remained unchanged . The levels of triglycerides increased significantly in the cyproterone acetate-treated group after the third month . CONCLUSION ( S ) Treatment of adolescent girls with PCOS with the two studied formulations is comparably effective in decreasing hirsutism and and rogen levels . Both combined oral contraceptives are associated with an increase of total cholesterol , LDL cholesterol , and HDL cholesterol levels and no change of the total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratios . Treatment with the cyproterone acetate combined oral contraceptive is associated with a tendency toward increasing the levels of triglycerides OBJECTIVE To test the hypothesis that statins improve hyper and rogenemia in women with polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve , r and omized trial . SETTING Academic medical center . PATIENT(S ) Forty-eight women with PCOS . INTERVENTION(S ) Subjects were r and omized to a statin group ( simvastatin , 20 mg daily plus oral contraceptive pill [ OCP ] ; n = 24 ) or an OCP group ( OCP alone ; n = 24 ) . MAIN OUTCOME MEASURE(S ) Serum T. RESULT ( S ) Baseline parameters of both groups were comparable . After 12 weeks of treatment , serum T levels declined by 41 % in the statin group and by 14 % in the OCP group . In the statin group , there was a greater decrease of LH ( 43 % decrease vs. 9 % in the OCP group ) and a greater decline of LH/FSH ratio ( 44 % vs. 12 % ) . In the statin group , total cholesterol declined by 10 % and low-density lipoprotein ( LDL ) by 24 % . In the OCP group , total cholesterol increased by 8 % , and LDL was unchanged . CONCLUSION ( S ) This is the first study demonstrating that statin decreases T levels and normalizes gonadotropin levels in women with PCOS . Statin therapy might offer a novel approach , providing endocrine and cardiovascular benefits The present study was design ed in order to : ( a ) compare ET-1 and ADMA levels , between women with PCOS ( n=106 ) and healthy controls ( n=30 ) ; ( b ) determine the effects of treatment with estrogens and anti- and rogens on the hormonal features of PCOS , insulin resistance , ET-1 and ADMA levels . Women with PCOS were r and omized in five therapeutic protocol s : ( I ) 17beta-estradiol+cyproterone acetate 50 mg ; ( II ) conjugated estrogen+CA 50 mg ; ( III ) ethinyl estradiole+CA 2 mg ; ( IV ) EE+CA 52 mg ; ( V ) EE+desogestrel . In all women , gonadotropin , PRL , and rogen , SHBG , insulin , glucose , ET-1 and ADMA levels were determined ; in women with PCOS , testosterone , SHBG , ET-1 and ADMA levels were measured again after 3 , 6 , 12 months of treatment and insulin and glucose levels after 12 months . ET-1 and ADMA concentrations were higher in women with PCOS , and they were positively correlated with each other . ADMA levels were decreased and IR was increased with treatment . Treatment with synthetic estrogens ( EE ) result ed in a more pronounced increase in SHBG and a more pronounced decrease in FAI , compared to natural estrogens . Conclusively , PCOS is associated with endothelial dysfunction , which is ameliorated by the administration of estrogens and anti- and rogens , independent of IR OBJECTIVE To assess the interaction between insulin resistance and endothelial function and the optimal treatment strategy addressing cardiovascular risk in polycystic ovary syndrome . DESIGN R and omized controlled trial . SETTING Controlled clinical study . PATIENT(S ) Overweight age- and body mass index-matched women with polycystic ovary syndrome . INTERVENTION(S ) Six months metformin ( 1 g two times per day , n = 36 ) or oral contraceptive pill ( OCP ) ( 35 microg ethinyl E(2)-2 mg cytoproterone acetate , n = 30 ) . MAIN OUTCOME MEASURE(S ) Fasting and oral glucose tolerance test glucose and insulin levels , endothelial function ( flow-mediated dilation , asymmetric dimethylarginine , plasminogen activator inhibitor-1 , von Willebr and factor ) , inflammatory markers ( high-sensitivity C-reactive protein ) , lipids , and hyper and rogenism . RESULT ( S ) The OCP increased levels of glucose and insulin on oral glucose tolerance test , high-sensitivity C-reactive protein , triglycerides , and sex-hormone binding globulin and decreased levels of low-density lipoprotein cholesterol and T.  Metformin decreased levels of fasting insulin , oral glucose 
    Output:
    