Combined oral contraceptive pill compared with no medical treatment in the management of polycystic ovary syndrome: A systematic review

Abstract

Objective As part of the update of the International Evidence‐Based Guidelines for the Assessment and Management of polycystic ovary syndrome (PCOS), a systematic review was performed to inform evidence‐based recommendations. Design Systematic review. Only randomised controlled trial were included. Patients Women with PCOS; the use of combined oral contraceptive pills (COCP) was compared with no medical treatment. Measurements Outcomes were designed in collaboration with clinical experts, researchers, and consumers. Critical outcomes included hirsutism, irregular cycles, quality of life, body mass index (BMI), and weight. Results 1660 publications were identified, but only four studies were included. No studies could be combined for meta‐analysis. COCP treatment improved cycle regularity compared with no medical treatment (100% vs. 0%, with low certainty of evidence). COCP showed no difference in improvement of hirsutism or BMI compared with placebo or lifestyle; a lower weight after COCP compared with no treatment (mean difference [MD] −8.0 (95% confidence interval, CI −11.67); −4.33 kg); and improvement in quality of life (MD 1.2 [95% CI 0.96]; 1.44), but these results were all very low certainty of evidence. Conclusion Results show that COCP benefit cycle regulation, but other benefits or potential adverse effects were only identified with very low certainty of evidence. The COCP is frontline medical treatment in PCOS, but this is still based on established efficacy in the broader general population. Our results show that research in PCOS is seriously lacking and should be prioritised to capture core reproductive, metabolic and psychological outcomes important in PCOS.

Efficacy and safety of anti-androgens in the management of polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials

“… 9 The COCP is often prescribed for adult women with PCOS, for management of irregular menses and clinical hyperandrogenism (hirsutism and acne). 10 Similarly, COCPs are recommended for adolescent girls diagnosed with PCOS and those considered to be “at risk for PCOS”. Metformin has been used for ovulation induction, promotion of weight loss and/or maintenance, and reduction of pregnancy complications.…”

Organokines and liver enzymes in adolescent girls with polycystic ovary syndrome during randomized treatments

“…The usually recommended off-label medication is an oral estroprogestagen contraceptive (OC) that is primarily used to revert androgen excess and restore menstrual regularity ( 24 ). However, this approach has a limited capacity to improve metabolic status ( 3 , 25 , 26 ) and may cause sustained unfavorable changes in hepatic markers ( 25 , 27 ). Currently, the research in progress focuses on the development of safer medications that reduce ectopic fat and/or increase energy expenditure ( 3 ).…”