What are the preferred Oral Contraceptive Pills (OCPs) for managing Polycystic Ovary Syndrome (PCOS)/hirsutism?

From the Guidelines

For managing PCOS and hirsutism, combined oral contraceptive pills (COCPs) containing ethinyl estradiol with anti-androgenic progestins, such as drospirenone or norgestimate, are the preferred first-line treatment option. These COCPs have been shown to suppress ovarian androgen production, increase sex hormone-binding globulin, and reduce free testosterone, thereby improving hirsutism and acne symptoms 1. The use of COCPs also regulates menstrual cycles and reduces the risk of endometrial cancer. A typical regimen includes pills with 20-35 mcg of ethinyl estradiol taken daily for 21 days followed by 7 days of placebo, or in a continuous regimen. Treatment should continue for at least 6-12 months to allow for visible improvement in hirsutism.

Some key points to consider when prescribing COCPs for PCOS and hirsutism include:

• The selection of a COCP with an anti-androgenic progestin, such as drospirenone or norgestimate, which has been shown to have a more favorable effect on androgen levels and hirsutism symptoms 1.
• The importance of proper screening for contraindications, such as smoking, hypertension, or history of thromboembolism, before starting COCP therapy.
• The potential side effects of COCPs, including nausea, breast tenderness, and slight risk of blood clots, which should be monitored and managed accordingly.
• The benefits of COCPs in regulating menstrual cycles, reducing acne, and improving overall quality of life for women with PCOS and hirsutism.

It is also worth noting that other treatment options, such as insulin-sensitizing agents, may be considered for women with PCOS who do not respond to COCPs or have contraindications to their use 1. However, COCPs remain the preferred first-line treatment option for managing PCOS and hirsutism due to their efficacy, safety, and benefits in regulating menstrual cycles and reducing androgen symptoms.

From the Research

Preferred Oral Contraceptive Pills (OCPs) for PCOS/Hirsutism

The management of Polycystic Ovary Syndrome (PCOS) and hirsutism often involves the use of Oral Contraceptive Pills (OCPs) to regulate hormonal imbalances and reduce symptoms. The preferred OCPs for PCOS/hirsutism are typically those that contain anti-androgenic progestins, which help to decrease androgen levels and improve hirsutism.

Types of OCPs Used for PCOS/Hirsutism

• Combined Oral Contraceptives (COCs) containing cyproterone acetate, such as ethinylestradiol/cyproterone acetate, are commonly used to treat hirsutism in PCOS patients 2, 3.
• COCs containing drospirenone, such as ethinyl estradiol/drospirenone, have also been shown to be effective in reducing hirsutism in PCOS patients 4.
• Other anti-androgenic medications, such as spironolactone and flutamide, may be used in combination with OCPs to treat hirsutism in PCOS patients 2, 5.

Efficacy of Different OCPs

• A study comparing the efficacy of ethinylestradiol/cyproterone acetate and ethinylestradiol/desogestrel in reducing hirsutism in PCOS patients found that both combinations were equally effective 6.
• Another study found that cyproterone acetate containing OCPs were more effective in treating clinical hirsutism in PCOS patients after 12 months of treatment 3.
• Drospirenone/ethinyl estradiol combination has been shown to exert significant anti-androgenic activity and improve facial hirsutism in PCOS patients 4.

Considerations for OCP Selection

• The choice of OCP for PCOS/hirsutism should be individualized based on the patient's symptoms, medical history, and contraceptive needs 5.
• Patients with insulin-resistance related comorbidities may require alternative treatments, such as metformin, in addition to or instead of OCPs 5.
• The use of anti-androgenic medications, such as spironolactone and flutamide, should be carefully monitored due to potential side effects and risks 2, 5.