From the Guidelines
Oral contraceptive pills (OCPs) are a first-line treatment for polycystic ovary syndrome (PCOS) in Canada, with combination OCPs containing both estrogen and progestin showing the greatest efficacy. The most commonly prescribed and effective options include Diane-35 (cyproterone acetate 2mg/ethinyl estradiol 35mcg), Yaz (drospirenone 3mg/ethinyl estradiol 20mcg), and Yasmin (drospirenone 3mg/ethinyl estradiol 30mcg) 1. These medications should be taken daily for at least 6-12 months to achieve optimal results, with many patients requiring longer-term therapy. OCPs work by regulating menstrual cycles, reducing androgen levels, improving hirsutism and acne, and providing contraception.
Some key benefits of OCPs in PCOS treatment include:
- Suppression of androgen secretion by the ovaries
- Increase in the level of circulating sex hormone binding globulin
- Reduction of the risk of endometrial cancer
- Improvement of hirsutism and acne
- Provision of contraception
Drospirenone-containing OCPs are particularly beneficial due to their anti-androgenic properties and minimal impact on metabolic parameters 1. For patients with more severe hyperandrogenism, Diane-35 may be more effective due to its stronger anti-androgenic effects. Treatment should be individualized based on the patient's specific PCOS symptoms, with regular follow-up every 3-6 months to assess efficacy and manage side effects.
Some important considerations for OCP treatment in PCOS patients include:
- Potential side effects such as nausea, breast tenderness, headaches, and the small increased risk of venous thromboembolism
- Risk factors such as smoking, obesity, or family history of clotting disorders that may increase the risk of venous thromboembolism
- The need for regular follow-up to assess efficacy and manage side effects
- The importance of individualizing treatment based on the patient's specific PCOS symptoms.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Comparative Efficacy of Oral Contraceptive Pills (OCP) for Polycystic Ovary Syndrome (PCOS) in Canada
- The efficacy of OCPs in treating PCOS has been studied in various research papers 2, 3, 4, 5, 6.
- A study published in 2014 found that combined oral contraceptives (OCs) are often the first-line treatment for PCOS, improving hyperandrogenism and regulating menstrual cycles 2.
- Another study published in 2012 compared the effects of drospirenone/ethinyl oestradiol alone or in combination with metformin on the elastic properties of the aorta in women with PCOS, and found that the combination treatment improved the elastic parameters of the aorta 3.
- A 2013 study investigated the effects of ethinyl estradiol/drospirenone plus spironolactone therapy on inflammation and cardiometabolic risk in PCOS, and found that the therapy improved androgen excess without adverse effects on adiposity, glucose tolerance, or lipid profile 4.
- A 2007 study found that a combined oral contraceptive containing 30 microg ethinyloestradiol and 3 mg drospirenone was effective in treating hyperandrogenism in women with PCOS, with significant improvements in hirsutism and testosterone levels 5.
- A 2010 study compared the efficacy of a drospirenone-containing combined oral contraceptive with a desogestrel-containing COC in women with PCOS, and found that the drospirenone-containing COC had better outcomes in terms of persistent regular cycles, antiandrogenic effect, and favorable lipid and glycemic profiles 6.
Key Findings
- OCPs are effective in improving hyperandrogenism and regulating menstrual cycles in women with PCOS 2, 5, 6.
- Combination therapy with metformin or antiandrogens may have additional benefits in improving cardiometabolic risk factors and elastic properties of the aorta 3, 4.
- Different formulations of OCPs may have varying effects on cardiometabolic risk factors, and further studies are needed to clarify the safety of long-term use of OCPs in PCOS 2, 6.