To determine whether insulin resistance occurs in polycystic ovarian disease (PCO) in the absence of obesity and acanthosis nigricans, circulating levels of insulin in response to oral glucose administration were measured in 10 nonobese PCO patients without acanthosis nigricans and in 10 normal women matched for weight and height. Mean serum testosterone (T), androstenedione (A), dehydroepiandrosterone (D), D sulfate, and LH levels were significantly elevated in the PCO patients compared to those in control subjects. In PCO patients, the mean +/- SE basal insulin level (18.7 +/- 2.9 microU/ml) and the sum of the insulin levels in response to glucose (674 +/- 119 microU/ml) were significantly greater than those in the control group (11.0 +/- 0.8 microU/ml and 248 +/- 29 microU/ml, respectively). In all subjects, serum levels of T and A, but not D and D sulfate, were significantly correlated to basal insulin levels and insulin sums. Serum cortisol, GH, and PRL levels were similar in both groups. These results indicate that in PCO, a significant degree of insulin resistance exists, which clearly is not related to obesity. The positive correlation of serum T and A levels to circulating insulin levels in this study suggests that the insulin resistance in PCO may be, in part, a consequence of hyperandrogenism.

OR YEARS, THERE HAS BEEN CONcern about possible associations of gynecologic malignancies with postmenopausal hormone therapy. The development of endometrial hyperplasia and endometrial cancer with unopposed estrogen is well recognized. To reduce or avoid this complication, progestin has been added, 1-3 although results from randomized trials are extremely limited. These concerns have created a need for reasonable monitoring guidelines to follow-up women who experience vaginal bleeding while taking estrogen plus progestin. The Women's Health Initiative (WHI) trial of estrogen plus progestin provides the first opportunity to examine possible associations of gynecologic malignancies with continuous combined postmenopausal hormone therapy in a large, randomized, double-blind, placebo-controlled setting. The trial was stopped early at the recommendation of the independent data and safety monitoring board on the basis of an increased risk of breast cancer supported by a summary measure of effects indicating risks exceeded