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

OCPs or Insulin Sensitizers for the Chronic Treatment of PCOS?

Insulin sensitizers, particularly metformin, have been suggested for the long-term treatment of PCOS as an alternative to OCPs.[80] Metformin reduces progression to diabetes in individuals with IGT albeit at a lower rate than lifestyle modification.[81] Insulin resistance is a major risk factor for CVD, and limited data suggest that metformin improves cardiovascular outcome in patients with type 2 diabetes.[82] Several, but not all, short-term studies of metformin showed improvement in cardiometabolic risk factors of women with PCOS suggesting that metformin is a promising agent for the chronic treatment of PCOS.[80] However, there are no long-term prospective trials assessing development of CVD or type 2 diabetes in women using either metformin alone or in comparison with OCPs. Short-term randomized clinical trial data comparing metformin and ethinyl estradiol cyproterone acetate combination in obese PCOS women suggest that there is no difference in development of glucose tolerance/diabetes between these treatments in 6 months of use.[77]

A recent Cochrane review comparing OCPs versus metformin in PCOS has identified only four randomized controlled trials in the literature[70,74,75,83] involving 104 subjects with a study duration ranging between 6 and 12 months.[84] This review reported, based on limited evidence, that OCP use does not show adverse metabolic risk compared with metformin use.[84]

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