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

OCP Use and CVD Risk in PCOS

Current literature supports the fact that many women with PCOS have increased cardiovascular risk factors suggesting that the risk of CVD is increased in the disorder.[47,48] Obesity, insulin resistance, dyslipidemia, and dysfibrinolysis are generally found to be more common in PCOS patients compared with healthy women.[49,50] Most of the studies in the literature found increased carotid intima media thickness in PCOS patients.[49,50] Moreover, one study reported increased coronary artery calcification measured by computed tomography in PCOS patients, although PCOS diagnosis itself did not predict independently the presence or degree of coronary calcification after controlling classic risk factors including BMI, fasting glucose, and lipids.[51] Nevertheless, despite the existence of several CVD risk factors in PCOS patients, there is no direct evidence of increased or premature morbidity or mortality from CVD in the syndrome.[49]

Regarding association of CVD risk and the individual components of the syndrome (i.e., hyperandrogenism and oligo-ovulation/anovulation);, limited available data yield conflicting results. Substantive evidence linking androgen excess in women to increased risk of CVD is lacking.[52] We should note, however, that phenotypic expression of PCOS is heterogenous.[53] For example, even nonobese patients who fulfill all the three criteria of the 2003 Rotterdam conference (i.e., having hirsutism, oligo-ovulation/anovulation, and polycystic ovaries); show an altered cardiometabolic risk profile depending on serum androgen levels.[54] On the other hand, epidemiologic data suggest that menstrual irregularity in reproductive-aged women significantly increases the risk for future coronary heart disease.[55]

As discussed previously, current use of low-dose OCPs in healthy women might increase CVD risk although that risk does not continue once OCPs are stopped.[18,22] The CVD risk is associated with increased age, smoking, and hypertension.[22] Accordingly, young nonsmoker women do not appear to possess any CVD due to OCP use. Intriguing data from the healthy population suggest that OCP use during reproductive years might be protective against CVD later in life.[18] Unfortunately, there are no data available in the literature assessing potential association of OCP use and CVD outcome in PCOS. Because PCOS patients do not have increased or premature morbidity or mortality from CVD despite having increased CVD risk factors, it would be interesting to test the hypothesis that long-term use of OCPs during reproductive years might be protective against CVD morbidity and mortality in PCOS later in life.

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