Risks, benefits size and clinical implications of combined oral contraceptive use in women with polycystic ovary syndrome

Sebastião Freitas De Medeiros

doi:10.1186/s12958-017-0313-y

Abstract

BackgroundPolycystic ovary syndrome (PCOS) is a complex condition with high risk for dyslipidemia, dysglycemia, venous thromboembolism, cardiovascular disease and metabolic syndrome. Because the combined oral contraceptive (COC) use has also been associated with impaired fasting glucose, insulin resistance and increased risk of thromboembolism disease, it is rationale to think that the combination of oral contraceptive and PCOS could make it worse or increase the risks.ObjectiveTo examine the current data regarding potential additional risks and benefits of contraceptive use, highlights the major gap in knowledge for designing future studies and, when possible, suggests an adequate COC formulation for a determined PCOS phenotype.MethodsEnglish-language publications reporting on the influence of COCS in the development of venous thromboembolism in PCOS patients published until 2017 were searched using PubMed, Cochrane database, and hand search of references found in consulted articles. Ranges of collected data are given; the pooled data are presented as median and first and third quartiles. Wilcoxon signed-ranks test for paired samples was used to compare before-after original data. P value was set at 0.05.ResultsMost of COCs preparations significantly decrease androgens, and increase sex-hormone binding globulin. Therefore, the benefits of COCs are clear in patients with proved hyperandrogenemia. Regarding the impact of COCs on carbohydrate metabolism of PCOS subjects, the data were inconsistent but they tended to show no additional risk. Regarding lipids, most COCs consistently increased high-density lipoprotein cholesterol, triglycerides and total cholesterol concentrations but the clinical implications of these changes need additional studies.ConclusionThe review showed consistent beneficial effect of COCs, particularly for hyperandrogenemic PCOS patients. The benefit size of COC’s use by normoandrogenemic PCOS patients is uncertain and need more investigation. The effects of COC use on carbohydrate metabolism of women with PCOS are still unresolved since most studies are observational but the current results demonstrated that COCs do not make their levels worse and may improve insulin sensitivity. The impact of COCs on lipids of PCOS patients seems to be clearer and most preparations increase total cholesterol, high-density lipoprotein cholesterol and triglycerides. In summary, it is important to balance the potential benefits and risks of the COCs individually before prescribing them for PCOS women.

Highlights

Polycystic ovary syndrome (PCOS) is a complex condition with high risk for dyslipidemia, dysglycemia, venous thromboembolism, cardiovascular disease and metabolic syndrome
These data demonstrate that PCOS patients exhibit many conditions that could be tightly linked to future development of cardiovascular disease (CVD) and venous thromboembolism (VTE) (Table 1)
Collectively, the available studies, either randomized controlled trials or prospective observational, suggest that the use of different COCs preparations do not get worse or bring additional harm for PCOS users, at least when used for 3–6 months

Summary

Introduction

Polycystic ovary syndrome (PCOS) is a complex condition with high risk for dyslipidemia, dysglycemia, venous thromboembolism, cardiovascular disease and metabolic syndrome. Adding evidences suggest that non-alcoholic fatty liver disease (NAFLD) exacerbates insulin resistance and predisposes patients with PCOS to an atherogenic status and the release of many proinflammatory, procoagulant and profibrogenic moderators [4]. These data demonstrate that PCOS patients exhibit many conditions that could be tightly linked to future development of cardiovascular disease (CVD) and venous thromboembolism (VTE) (Table 1). This review has several purposes: (a) to consider the potential risks of isolated PCOS; (b) to estimate the potential additional risks of COC in patients with PCOS; (c) to examine why the use of COCs would be either beneficial or harmful for PCOS patients; (d) to focus on the noncontraceptive advantages/disadvantages of COC use in this syndrome; and (e), when possible, to suggest a specific formulation according to the patients’ phenotype

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Results

Conclusion