From the Guidelines
For managing Polycystic Ovary Syndrome (PCOS) symptoms, a combination oral contraceptive pill (OCP) is the recommended regimen. The use of combination oral contraceptive pills has demonstrated benefits including the suppression of androgen secretion by the ovaries and an increase in the level of circulating sex hormone binding globulin 1. This approach is supported by guidelines from reputable medical organizations, which suggest that long-term management of PCOS most often involves the use of combination oral contraceptive pills 1.
When selecting an OCP for PCOS, it's essential to consider the type of progestin, as some have anti-androgenic properties that can be beneficial for PCOS patients. However, the optimal progestin and the optimal duration and frequency of treatment to prevent endometrial cancer in women with PCOS is not known 1.
Key benefits of using OCPs for PCOS include:
- Suppression of ovarian androgen production
- Increase in sex hormone-binding globulin
- Regulation of menstrual cycles
- Improvement in symptoms such as irregular periods, acne, and hirsutism
It's crucial to note that while OCPs are effective in managing PCOS symptoms, they may have side effects, and their use should be carefully considered in women with certain medical conditions. Additionally, other treatments, such as insulin-sensitizing agents, may also be used in conjunction with OCPs to manage PCOS symptoms 1.
In terms of specific regimens, a common approach is to use a low-dose combination pill containing 20-35 mcg of ethinyl estradiol paired with a progestin. The standard regimen involves taking active hormone pills for 21 days followed by 7 days of placebo pills, though extended or continuous regimens can be used to further reduce symptoms. Treatment should continue for at least 6-12 months to evaluate effectiveness, but many patients benefit from longer-term use.
From the Research
Oral Contraceptive Pill (OCP) Regimens for PCOS
The management of Polycystic Ovary Syndrome (PCOS) symptoms often involves the use of oral contraceptive pills (OCPs) to regulate menstrual cycles and reduce hyperandrogenism. Key points to consider include:
- The 2013 Endocrine Society guidelines recommend the use of hormonal contraceptives for treating menstrual irregularity and hirsutism in patients with PCOS 2.
- A study comparing the efficacy of metformin and an oral contraceptive containing drospirenone found that metformin regularized menstrual cycles in 72% of patients, while the oral contraceptive decreased serum testosterone levels and improved hirsutism symptoms 2.
- Another study demonstrated the efficacy of an oral contraceptive containing drospirenone in improving hirsutism, decreasing testosterone levels, and increasing sex hormone-binding globulin (SHBG) levels in women with PCOS 3.
Recommended OCP Regimens
Recommended OCP regimens for PCOS include:
- Combined oral contraceptives (COCs) containing ethinyl estradiol and drospirenone, which have been shown to improve hirsutism, regulate menstrual cycles, and decrease androgen levels 3, 4.
- COCs plus spironolactone, which have been compared to metformin in a randomized clinical trial and found to be more effective in reducing hirsutism, androgen excess, and menstrual dysfunction 5.
- COCs containing ethinyl estradiol and desogestrel, which have been used in combination with spironolactone to improve PCOS symptoms 5.
Considerations and Precautions
When using OCPs to manage PCOS symptoms, consider the following:
- Metformin may be reserved for women with only menstrual irregularity, as it has limited benefits in treating hyperandrogenism associated with PCOS 2.
- The choice of progestin component in COCs is important, as some progestins may have anti-androgenic effects that can benefit women with PCOS 4.
- The metabolic effects of COCs in PCOS are still a topic of debate, and the impact on insulin sensitivity, glucose tolerance, and lipid levels should be carefully considered 6.