From the Guidelines
Oral contraceptive pills (OCPs) are a first-line treatment for polycystic ovary syndrome (PCOS), as they regulate menstrual cycles, reduce androgen levels, and improve symptoms such as acne and hirsutism, as supported by the most recent evidence from 2020 1. The standard regimen for OCPs in PCOS management involves taking one pill daily for 21 days, followed by 7 days of placebo pills or no pills, and then repeating the cycle. Some key benefits of OCPs in PCOS management include:
- Regulating menstrual cycles
- Reducing androgen levels
- Improving acne and hirsutism
- Providing contraception
- Protecting against endometrial hyperplasia The estrogen component of OCPs increases sex hormone-binding globulin, which binds free testosterone, while the progestin suppresses luteinizing hormone, reducing ovarian androgen production, as noted in earlier guidelines 1. However, it's essential to consider the potential side effects of OCPs, such as nausea, breast tenderness, headaches, and mood changes, which typically improve after 2-3 months. OCPs are contraindicated in women with certain conditions, including a history of blood clots, stroke, breast cancer, liver disease, or in smokers over 35 years old. Regular follow-up every 3-6 months is recommended to assess effectiveness and manage side effects, as part of a comprehensive approach to PCOS management that may also include lifestyle modifications, such as weight loss and exercise, as emphasized in the 2020 guideline 1.
From the Research
Overview of OCP for PCOS
- Combined oral contraceptives (COCs) are a common treatment for polycystic ovary syndrome (PCOS) 2, 3
- COCs can help regulate menstrual cycles, improve hyperandrogenism, and reduce the risk of endometrial cancer 2
- However, COCs can also increase the risk of venous thromboembolism (VTE) and may have other cardiometabolic risks 2
Types of Progestins Used in OCP for PCOS
- Drospirenone is a progestin that has been shown to have anti-androgenic effects and may be beneficial for women with PCOS 3, 4
- Other progestins, such as desogestrel and dienogest, may also be used in COCs for PCOS, but their effects may vary 4, 5
- The choice of progestin may depend on individual patient factors, such as the presence of cardiometabolic risk factors 2
Effects of OCP on Clinical and Biochemical Parameters in PCOS
- COCs can improve acne, hirsutism, and menstrual regularity in women with PCOS 3, 4
- COCs may also have beneficial effects on body mass index (BMI), blood pressure, and lipid profiles 4
- However, the effects of COCs on these parameters may vary depending on the type of progestin used and individual patient factors 4, 5
Comparison of OCP with No Medical Treatment in PCOS
- COCs have been shown to improve cycle regularity and quality of life in women with PCOS compared to no medical treatment 6
- However, the evidence for other benefits of COCs in PCOS, such as improvement in hirsutism or BMI, is limited and of low certainty 6
- Further research is needed to fully understand the effects of COCs in PCOS and to inform evidence-based treatment recommendations 6