Contraceptive Choice in Women with PCOS

Abstract

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of reproductive age. It is characterized by chronic anovulation, hyperandrogenism and polycystic ovary morphology. This syndrome is strictly related to many metabolic disorders, as overweight, metabolic syndrome and insulin resistance. These features, together with hyperandrogenism, contribute to increase the risk of developing type 2 diabetes mellitus and cardiovascular diseases later in life.Women with PCOS can ask the clinician for hormonal contraception. Combined hormonal contraceptives (CHCs) are the most used for these women, because they combinate the advantages of a safe contraceptive and the positive effects that some kinds of estrogens and progestins can have on hyperandrogenism, increasing sex hormone binding globulin levels and decreasing total and free testosterone and free androgen index. However, attention must be paid to the metabolic features of PCOS women, because CHCs may worsen the lipid and glycemic profile and increase body weight.This text wants to help the clinician in the choice of the right hormonal contraceptive for patients with PCOS. It summarizes the most recent guidelines and studies, giving information on which estroprogestin combination needs consideration on the base of the main characteristics and problems of the patient. Moreover, the main metabolic side effects of the most used CHCs are reported.