Risks, benefits size and clinical implications of combined oral contraceptive use in women with polycystic ovary syndrome

Abstract

BackgroundPolycystic ovary syndrome (PCOS) is a complex condition with high risk for dyslipidemia, dysglycemia, venous thromboembolism, cardiovascular disease and metabolic syndrome. Because the combined oral contraceptive (COC) use has also been associated with impaired fasting glucose, insulin resistance and increased risk of thromboembolism disease, it is rationale to think that the combination of oral contraceptive and PCOS could make it worse or increase the risks.ObjectiveTo examine the current data regarding potential additional risks and benefits of contraceptive use, highlights the major gap in knowledge for designing future studies and, when possible, suggests an adequate COC formulation for a determined PCOS phenotype.MethodsEnglish-language publications reporting on the influence of COCS in the development of venous thromboembolism in PCOS patients published until 2017 were searched using PubMed, Cochrane database, and hand search of references found in consulted articles. Ranges of collected data are given; the pooled data are presented as median and first and third quartiles. Wilcoxon signed-ranks test for paired samples was used to compare before-after original data. P value was set at 0.05.ResultsMost of COCs preparations significantly decrease androgens, and increase sex-hormone binding globulin. Therefore, the benefits of COCs are clear in patients with proved hyperandrogenemia. Regarding the impact of COCs on carbohydrate metabolism of PCOS subjects, the data were inconsistent but they tended to show no additional risk. Regarding lipids, most COCs consistently increased high-density lipoprotein cholesterol, triglycerides and total cholesterol concentrations but the clinical implications of these changes need additional studies.ConclusionThe review showed consistent beneficial effect of COCs, particularly for hyperandrogenemic PCOS patients. The benefit size of COC’s use by normoandrogenemic PCOS patients is uncertain and need more investigation. The effects of COC use on carbohydrate metabolism of women with PCOS are still unresolved since most studies are observational but the current results demonstrated that COCs do not make their levels worse and may improve insulin sensitivity. The impact of COCs on lipids of PCOS patients seems to be clearer and most preparations increase total cholesterol, high-density lipoprotein cholesterol and triglycerides. In summary, it is important to balance the potential benefits and risks of the COCs individually before prescribing them for PCOS women.

Clinical, hormonal and metabolic parameters in women with PCOS with different combined oral contraceptives (containing chlormadinone acetate versus drospirenone)

“…Hyperandrogenism is best treated with antiandrogen-acting progestins. For example, gestagens such as DRSP or CMA have strong antiandrogenic effects [28].…”

Pharmacological Approaches to Controlling Cardiometabolic Risk in Women with PCOS

“…Combined oral contraceptives (COCs) are recommended by Endocrine Society guideline as first-line treatment for menstrual abnormalities and hyperandrogenic disorders in PCOS women not seeking fertility [ 75 ]. However, their use has been associated with the onset of glucose intolerance, hypertension, hypertriglyceridemia, and elevated CRP levels in healthy women [ 152 , 153 ]. For these reasons, the use of COCs has been suggested to be an additional cardiovascular risk factor in PCOS, given the high prevalence of IR, central obesity, diabetes, hypertension, and dyslipidemia in these patients [ 154 ].…”

“…At present, the effects of COCs on cardiometabolic aspects are still controversial, because available studies are mainly small, short-term, and very heterogeneous due to several COC formulations used [ 152 , 153 ]. Indeed, the combination of different types and doses of estrogen with the type of progestin used may strongly influence not only hormonal findings but also thromboembolic and cardiometabolic risk, which also varies according to age, body type, and genetic predisposition of the patient.…”

Síndrome de ovario poliquístico

“…Sin embargo niveles de Colesterol Total, Trigliceridos y HDL-C son consistentemente aumentados por los ACO, aun así las implicaciones clínicas de estos cambios aún necesitan investigación a largo plazo. 13 La hipercolesterolemia leve no afecta el perfil hormonal de los pacientes con SOP; por lo tanto, hasta la fecha, no hay evidencia que sugiera su tratamiento para la corrección de las anormalidades menstruales y hormonales en esta población específica. 14 Consistentemente, la pérdida de peso mediante modificación del estilo de vida (que incluye guía dietética, actividad física y / o cambio de comportamiento), medicamentos (metformina, orlistat, incretinomiméticos) o cirugía bariátrica mejora la resistencia a la insulina, reduciendo el HAo y alivia la gravedad clínica.…”