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

Long-Term Use of OCPs and Cardiometabolic Risk in PCOS

Only a few long-term observational studies evaluating the metabolic effects of OCPs in PCOS are available in the literature. In a prospective open-label study, lipid profiles and glucose homeostasis were evaluated in 72 PCOS women treated with ethinyl estradiol/cyproterone acetate for 3 years in comparison with 39 healthy women.[78] At baseline, women with PCOS had higher levels of total cholesterol and triglycerides and lower levels of high-density (HDL);-cholesterol. The investigators observed an increase in triglycerides and HDL-cholesterol and a decrease in low-density lipoprotein (LDL);/HDL ratio in PCOS women after the treatment. More importantly, insulin and glucose plasma concentrations did not change.[78]

Pasquali et al conducted another small observational study on 37 PCOS patients with an average follow-up of 10 years (range, 12 to 180 months); to assess the long-term effects of OCPs on cardiometabolic risk factors in PCOS patients.[79] The mean ages at the beginning and the end of the follow-up were 18 and 29 years for the OCP users and 21 and 31 years for the non-OCP users. Sixteen patients were on OCP treatment (ethinyl estradiol combined with either cyproterone acetate or gestodene or desogestrel);, and 21 patients had never used OCPs. None of the anthropometric measurements changed in non-OCP users during the follow-up including body weight, BMI, waist and hip circumferences, and waist-to-hip ratio (WHR);. Alternatively, waist circumference and WHR was significantly reduced in OCP users. Area under the curve (AUC); for glucose during OGTT decreased in OCP users and was unchanged in non-OCP users, whereas AUC for insulin was unchanged in OCP users but increased in non-OCP users. Finally, HDL-cholesterol and SHBG levels increased significantly only in the OCP users, whereas there was no change in non-OCP users.[79]

Taken together, findings of these studies suggest that insulin resistance worsens during the natural course of the syndrome, whereas long-term OCP use either does not change or improves the cardiometabolic risk parameters including insulin resistance, lipoprotein profile, and potentially body fat distribution.

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