Oral Contraceptives in Polycystic Ovary Syndrome: Risk-Benefit Assessment

Conclusions

The OCPs are a key component of the chronic treatment of PCOS addressing many of the goals of the reproductive-aged PCOS women not seeking pregnancy. Earlier epidemiologic studies of OCPs in healthy women have raised concern regarding potential adverse cardiometabolic effects associated with the long-term use of these agents. Only a few studies assessing the metabolic effects of OCPs in PCOS are available in the literature. The randomized controlled trials are even fewer. Most of the studies had a small number of participants with a limited follow-up period, and several confounding factors that might have influenced the results were not taken into account in these studies. Long-term risks and benefits of the use of combined oral contraception delivered by non-oral routes (i.e., transdermal or vaginal); or the use of OCPs combined with other treatment modalities such as antiandrogens or insulin sensitizers remain largely unknown.

Larger randomized controlled studies are undoubtedly needed to resolve controversies about OCPs and to address important questions raised by earlier studies in the literature. The recent Rotterdam criteria for the definition of PCOS have introduced more heterogeneity to the clinical phenotypes with potentially varying degrees of cardiometabolic risk starting from the diagnosis. New low-dose OCPs containing antiandrogenic progestins with a better safety profile are now available. Accordingly, future studies evaluating the long-term effects of OCPs in the treatment of PCOS should adequately consider clinical heterogeneity of the syndrome and variation in the efficacy and safety of different combinations. Despite the unresolved questions about overall long-term safety and potential variable effects in different phenotypes, current evidence support the benefits of long-term OCP use in PCOS. However, it should be kept in mind that OCP use might increase the risk of diabetes particularly in obese patients with severe insulin resistance. Continued development of effective long-term treatment options for PCOS is needed. Meanwhile, It is critical that the WHO guidelines for the contraindications to OCP use should be exercised in women with PCOS and that the precise individualized treatment targets and risk stratification depending on patient characteristics be determined.

This work was supported, in part, by the Turkish Academy of Sciences (grant TUBA-GEBIP 2006);.

Semin Reprod Med. 2008;26(1):111-120. © 2008  Thieme Medical Publishers