Menstrual cyclicity post OC withdrawal in PCOS: Use of non-hormonal options

Abstract

There is no data on menstrual cyclicity post oral contraceptive (OC) withdrawal with nonhormonal options in PCOS patients. OC could affect obesity, insulin and gonadotropins factors integral to pathogenesis of PCOS, thereby adversely affecting the HPG axis. Menstrual cycles of PCOS patients were retrospectively studied post OCP. Patients developing regular versus irregular cycles post OC were compared. Forty-eight PCOS patients were followed for an average of 1.9 years post OC. Thirty-six (75%) achieved regular cycles over a period of one year with other nonhormonal options like spironolactone and metformin. Seven patients required no treatment. Patients who continued to have irregular cycles had a longer pre OC cycle length (p < 0.01) and a greater duration of menstrual irregularity (p < 0.02), though age, BMI and hormones were similar in the two groups. In conclusion, spironolactone and metformin are effective nonhormonal options for regular periods post OC. Around 15% PCOS may not require any treatment post OC.

Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India

“…A comparison of metformin and OCP (EE plus drospirenone) was done as a prospective observational study (n=46) over one year by Suvarna et al 83, and metformin alone was found to be equally effective in regularizing menstrual cycles and treating hyperandrogenism in Indian women with PCOS. Use of non-hormonal options i.e ., metformin and spironolactone, after a period of oral contraceptive use, was retrospectively studied by Kulshreshtha et al 84, in a small group of women with PCOS for regularization of their menstrual cycles. They concluded that 75 per cent of women achieved regular cycles with non-hormonal treatment within one year of stopping OCPs.…”