Noncontraceptive use of oral combined hormonal contraceptives in polycystic ovary syndrome—risks versus benefits

Use of oral combined hormonal contraceptives as a first-line treatment in women with polycystic ovary syndrome requires regular assessment of cardiometabolic and other risk factors.

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Volume 106, Issue 7, Pages 1572-1579

Authors:

Anuja Dokras, M.D., Ph.D.

Abstract:

The use of steroid sex hormones for noncontraceptive benefits has been endorsed by several medical societies. In women with polycystic ovary syndrome (PCOS), hormonal contraceptives are first-line therapy for concurrent treatment of menstrual irregularity, acne, and hirsutism. The association of PCOS with obesity, diabetes, and dyslipidemia frequently brings up the debate regarding risks versus benefits of hormonal contraceptives in this population. In women with PCOS, the lack of large-scale studies evaluating the risks with varying doses of ethinyl estradiol, types of progestins, and presence of confounding factors such as obesity, smoking, and other cardiometabolic comorbidities is a significant limitation in these deliberations. Although it is important to assess the absolute risk for major morbidities including cardiovascular events, currently, there are a paucity of long-term data for these outcomes in PCOS. Most of the current studies do not suggest an increase in risk of prediabetes/diabetes, clinically significant dyslipidemia, inflammatory changes, or depressive/anxiety symptoms with oral contraceptive pill use. Screening of women with PCOS for cardiometabolic and psychiatric comorbidities is routinely recommended. This information should be used by health care providers to individualize the choice of hormonal contraceptive treatment, adequately counsel patients regarding risks and benefits, and formulate an appropriate follow-up plan.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

1 Comments

Go to the profile of Alexander Quaas
Alexander Quaas almost 4 years ago

This review provides an overview of the risk-benefit balance of OCP use in patients with PCOS and demonstrates that in most instances it is tipped in favor of OCP use- given that the benefits outweigh the risks in most (young) patients with PCOS. One interesting learning point is the fact that lower doses of ethinyl estradiol (20 mg) effectively decrease androgens and should be used as part of first-line combined hormonal treatment- it appears to me that there is still a widespread misconception that in PCOS patients higher EE doses are indicated.