Metabolic and cardiovascular impact of oral contraceptives in polycystic ovary syndrome

Abstract

Chronic anovulation, polycystic ovarian morphology and hyperandrogenism are the diagnostic criteria for polycystic ovary syndrome (PCOS). Metabolic disturbances are more common in PCOS women who are prone to develop metabolic syndrome and to present higher levels of some cardiovascular disease risk marker. Oral contraceptives are widely used in PCOS, but conflicting data have been reported regarding their impact on carbohydrate and lipid metabolism on PCOS women. This paper presents a critical evaluation of combined oral contraceptives (COCs) metabolic effect - carbohydrate metabolism and insulin sensitivity, lipid metabolism, haemostasis, body weight, arterial pressure and cardiovascular impact - on PCOS women. Because of the paucity of data on the impact of COCs on cardiovascular and metabolic parameters in PCOS patients, most of there commendations are based on studies involving ovulatory women. The use of low-dose COCs is preferable in PCOS, especially among patients with glucose intolerance, insulin resistance and uncomplicated diabetes mellitus. Although reported as a side effect of COCs, marked weight gain has not been confirmed among users. However, when arterial hypertension or elevated risk for thromboembolism is present, progestogen-only hormonal contraceptives should be used instead of COCs. Regarding dyslipidaemia, COCs reduce low-density lipoprotein and total cholesterol and elevate high-density lipoprotein and triglycerides, and therefore are not recommended for women with high triglycerides levels. The choice of a COC, which alleviates the PCOS-induced hyperandrogenism without significant negative impact on cardiovascular risk, is one of the greatest challenges faced by gynaecologists nowadays.

Effect of Aloe barbadensis Mill. formulation on Letrozole induced polycystic ovarian syndrome rat model

“…[12] PCOS is characterized by hyperandrogenism, insulin insensitivity, and chronic anovulation. [3] Research over the last few decades has established that PCOS is an important metabolic disorder, associated with an increased risk of T2DM as well as metabolic syndrome. [4] It has been proposed women who have mild hyperandrogenism and an isolated ultrasonic finding of polycystic ovaries but whose ovulatory function is maintained exhibit a mild form of PCOS.…”

Metabolic and hormonal aspects of polycystic ovary syndrome: the impact of diet

“…Furthermore, current widely used pharmacological treatments for PCOS are not without drawbacks. Gastrointestinal side effects are commonly experienced with metformin (59) , and oral contraceptive pill usage is linked with increased metabolic irregularities (60) , which further complicate the clinical picture. The efficacy of long-term lifestyle interventions has been highlighted by work conducted as part of a large-scale clinical trial aimed at preventing the onset of T2DM in high-risk individuals.…”

The effects of old, new and emerging medicines on metabolic aberrations in PCOS

“…The combined oral contraceptives (COCs), are those more frequently used for this purpose. COCs contain an estrogen component (ethynyl-oestradiol) and a progestogen component that varies and binding to receptors of other steroid hormones [Soares et al 2009]. OCs that comprise of only progesterone have also been used as a therapeutic option [Soares et al 2009].…”

“…COCs contain an estrogen component (ethynyl-oestradiol) and a progestogen component that varies and binding to receptors of other steroid hormones [Soares et al 2009]. OCs that comprise of only progesterone have also been used as a therapeutic option [Soares et al 2009]. OC administration in women with PCOS, in most cases, normalizes menses and alleviates hirsuitism and acne and sometimes results in the regression of male-pattern alopecia [Glueck et al 2002;Kahn and Gordon, 1999].…”