Endocrinol Metab.  2021 Apr;36(2):296-311. 10.3803/EnM.2021.958.

An Update on Contraception in Polycystic Ovary Syndrome

• Oguz SH
• Yildiz BO

• KMID: 2515456
• DOI: http://doi.org/10.3803/EnM.2021.958

Abstract

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, characterized by hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology. Combined oral contraceptives (COCs), along with lifestyle modifications, represent the first-line medical treatment for the long-term management of PCOS. Containing low doses of estrogen and different types of progestin, COCs restore menstrual cyclicity, improve hyperandrogenism, and provide additional benefits such as reducing the risk of endometrial cancer. However, potential cardiometabolic risk associated with these agents has been a concern. COCs increase the risk of venous thromboembolism (VTE), related both to the dose of estrogen and the type of progestin involved. Arterial thrombotic events related to COC use occur much less frequently, and usually not a concern for young patients. All patients diagnosed with PCOS should be carefully evaluated for cardiometabolic risk factors at baseline, before initiating a COC. Age, smoking, obesity, glucose intolerance or diabetes, hypertension, dyslipidemia, thrombophilia, and family history of VTE should be recorded. Patients should be re-assessed at consecutive visits, more closely if any baseline cardiometabolic risk factor is present. Individual risk assessment is the key in order to avoid unfavorable outcomes related to COC use in women with PCOS.

Keyword

Polycystic ovary syndrome; Contraceptives; oral; Cardiometabolic risk factors; Obesity; Diabetes mellitus; Hypertension

Figure

• 

  Fig. 1 Currently available combined oral contraceptive preparations according to estradiol dosage and the type of progestin, and metabolic and androgenic side effects of the progestin component. The metabolic adverse events of combined oral contraceptives are associated with both the dose of the estradiol component and the type of progestin involved. Combinations containing lowered doses of ethinyl estradiol (EE; ≤35 μg) and more physiological forms like estradiol valerate (E2V) may be chosen in order to reduce metabolic risks. First- and second-generation progestins having androgenic and metabolic side effects are usually not favored in women with polycystic ovary syndrome. Third- and fourth-generation progestins cause fewer metabolic adverse effects, and fourth-generation progestins are also anti-androgenic. Cyproterone acetate has the greatest anti-androgen activity among all progestins.

• 

  Fig. 2 Assessment algorithm in women with polycystic ovary syndrome (PCOS) before prescribing a combined oral contraceptive. OGTT, oral glucose tolerance test; hCG, human chorionic gonadotropin.

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