Oral Contraceptives in Polycystic Ovary Syndrome: Risk-Benefit Assessment

Bulent O. Yildiz, M.D.

Disclosures

Semin Reprod Med. 2008;26(1):111-120. 

In This Article

Abstract and Introduction

Combined oral contraceptive pills (OCPs); have been a key component of the chronic treatment of polycystic ovary syndrome (PCOS); by improving androgen excess and regulating menstrual cycles. Earlier epidemiologic studies with second- and third-generation OCPs in the general population have raised important questions regarding long-term cardiometabolic effects of these agents. In PCOS, there are only a few short-term studies with contradictory results evaluating potential adverse effects of OCPs on cardiovascular risk factors and glucose homeostasis. These studies included a small number of participants and did not take into account several confounding factors that might influence the outcome. Nevertheless, limited available data support the benefits of long-term OCP use in PCOS. By contrast, solid evidence for cardiometabolic adverse outcome with the use of these agents, especially with newer OCPs containing antiandrogenic progestins, is lacking. More studies are needed to resolve controversies regarding the safety of long-term OCP use in PCOS. Meanwhile, assessment of each PCOS patient's personal cardiometabolic risk profile should be an essential component of the evaluation before prescribing OCPs and also during follow-up.

Polycystic ovary syndrome (PCOS); is a common and complex disorder characterized by androgen excess, ovulatory dysfunction, and polycystic ovaries.[1] Women with PCOS typically present with clinical evidence of hyperandrogenism (e.g., hirsutism);, menstrual irregularity, and infertility. Accordingly, current treatment regimens are directed at reduction of hirsutism and/or acne, menstrual cycle regulation, and achieving pregnancy.[2] Combined oral contraceptive pills (OCPs); have traditionally been the mainstay of treatment for amelioration of hyperandrogenism and regulation of menstrual cycles in PCOS patients not seeking pregnancy.[3]

Potential adverse cardiometabolic effects of OCPs represent a major concern given that these drugs are used for the chronic treatment of PCOS.[4,5] Here, we will briefly review the use of OCPs in healthy women and in PCOS with a special emphasis on the long-term benefits and risks of these agents.

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