From the Guidelines
Oral contraceptives are a highly effective method for reducing cardiovascular and metabolic risks in PCOS patients by addressing underlying hormonal imbalances, with the most recent evidence supporting their use as a first-line treatment. Combined oral contraceptives (COCs) containing ethinyl estradiol with progestins like drospirenone, cyproterone acetate, or desogestrel are particularly beneficial, as they work by suppressing androgen production from the ovaries, increasing sex hormone-binding globulin levels, and decreasing insulin resistance 1. The estrogen component helps improve lipid profiles by increasing HDL cholesterol and reducing LDL cholesterol, while certain progestins have anti-androgenic effects that address hirsutism and acne.
Key benefits of oral contraceptives in PCOS patients include:
- Suppression of androgen secretion by the ovaries
- Increase in the level of circulating sex hormone binding globulin
- Reduction in the risk of endometrial cancer
- Improvement in lipid profiles
- Decrease in insulin resistance
- Regulation of menstrual cycles, reducing the risk of endometrial hyperplasia and cancer associated with chronic anovulation in PCOS
A typical regimen involves taking COCs daily for 21 days followed by a 7-day break, with treatment continuing for at least 6-12 months to see significant metabolic improvements. For optimal results, COCs should be combined with lifestyle modifications including regular exercise and a balanced diet. However, patients with PCOS who smoke, have high blood pressure, or history of thromboembolism should discuss alternative treatments with their healthcare provider as COCs may be contraindicated in these cases 1. Additionally, insulin-sensitizing agents such as metformin may be used in conjunction with oral contraceptives to further improve metabolic outcomes in PCOS patients 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Mechanisms of Cardiovascular and Metabolic Risk Reduction
- Oral contraception has been shown to lower cardiovascular and metabolic risk in Polycystic Ovary Syndrome (PCOS) patients by improving insulin sensitivity and reducing androgen levels 2, 3.
- Combined oral contraceptives (COCs) can decrease insulin resistance and improve glucose tolerance, although the negative influence on insulin sensitivity is dependent on other factors such as obesity 3.
- COCs can also improve lipid profiles by reducing low-density lipoprotein and total cholesterol and elevating high-density lipoprotein and triglycerides, although they are not recommended for women with high triglycerides levels 4.
Benefits and Risks of Oral Contraceptives in PCOS Patients
- The benefits of hormonal contraception outweigh the risks in the vast majority of women with PCOS, but concerns have been raised about potential adverse cardiovascular and metabolic effects of oral contraceptives (OCs) 2.
- OC use might be associated with increased risk of diabetes in morbidly obese women with PCOS with severe insulin resistance, and individualized risk stratification and management are required 2.
- A tailored clinical approach to oral contraception in women with PCOS requires determination of each PCOS patient's personal cardiometabolic risk profile at baseline and during follow-up 2.
Choice of Oral Contraceptives for PCOS Patients
- The choice of a COC that alleviates PCOS-induced hyperandrogenism without significant negative impact on cardiovascular risk is one of the greatest challenges faced by gynaecologists 4.
- Low-dose COCs are preferable in PCOS, especially among patients with glucose intolerance, insulin resistance, and uncomplicated diabetes mellitus 4.
- Combination therapy of COC with weight reduction or insulin sensitizers could further suppress androgen levels and improve metabolic parameters 3.
Long-term Effects of Oral Contraceptives in PCOS Patients
- Long-term use of oral contraceptives needs to be considered carefully for PCOS patients who are already burdened with associated risk factors such as diabetes mellitus, dyslipidemia, and coronary vascular disease 5.
- Large-scale, long-term studies need to be designed to further evaluate the safety and efficacy of oral contraceptives in PCOS women 5.