From the Guidelines
For PCOS, I recommend starting with a combined oral contraceptive pill (OCP) containing ethinyl estradiol with either drospirenone (like Yaz or Yasmin) or norgestimate (like Ortho Tri-Cyclen), as these formulations have been shown to effectively address multiple symptoms of PCOS, including acne, hirsutism, and menstrual irregularity, with moderate certainty evidence from recent studies 1.
Key Considerations
- The estrogen component in these OCPs helps regulate menstrual cycles and reduces excess androgen production.
- The progestin component, especially drospirenone, has anti-androgenic properties that help with acne and hirsutism.
- Start with a standard dose (typically 20-35 mcg ethinyl estradiol) and take continuously for at least 3-6 months to evaluate effectiveness.
Alternative Options
- For patients with contraindications to estrogen, alternatives include progestin-only pills or an IUD with levonorgestrel, though these may be less effective for PCOS symptoms 1.
Monitoring and Follow-up
- Monitor for improvement in menstrual regularity, acne, and hirsutism, which typically begins within 3 months but may take up to 6 months for maximum benefit.
- Consider switching to a lower-dose option (20 mcg ethinyl estradiol) if side effects occur.
From the Research
Oral Contraceptive Options for PCOS
When considering oral contraceptive pills (OCPs) for the treatment of Polycystic Ovary Syndrome (PCOS), several factors must be taken into account, including the type of progestin and the potential cardiometabolic risks associated with their use 2. The following are some key points to consider:
- Combined Oral Contraceptives (COCs): COCs are a common treatment option for PCOS, as they can help regulate menstrual cycles, improve hyperandrogenism, and provide additional benefits such as reducing the risk of endometrial cancer 2.
- Drospirenone: Drospirenone is a progestin that has been shown to have anti-androgenic effects, making it a potentially beneficial option for women with PCOS 3, 4, 5, 6.
- Ethinyl Estradiol/Drospirenone Combination: The combination of ethinyl estradiol and drospirenone has been studied in several trials and has been shown to be effective in improving hyperandrogenism and regulating menstrual cycles in women with PCOS 3, 4, 5, 6.
- Metformin Combination: Adding metformin to OCP treatment may provide additional benefits, such as improving insulin sensitivity and reducing cardiovascular disease risk 4, 6.
Key Considerations
When selecting an OCP for PCOS, the following factors should be considered:
- Cardiometabolic Risk: Patients with PCOS should be carefully evaluated for cardiometabolic risk factors, such as age, smoking, obesity, glucose intolerance, and family history of venous thromboembolism 2.
- Individual Risk Assessment: Each patient's individual risk factors should be taken into account when selecting an OCP, and regular monitoring of cardiometabolic parameters is recommended 2.
- Treatment Goals: The treatment goals for each patient should be considered, including regulating menstrual cycles, improving hyperandrogenism, and reducing the risk of endometrial cancer.
Some potential OCP options for PCOS include: