Efficacy of Treatments for Polycystic Ovarian Syndrome Management in Adolescents

Abstract

Limited evidence on treatment options for polycystic ovarian syndrome (PCOS) has led to considerable variation in healthcare practices. We aimed to compare the effects of metformin and/or oral contraceptive pills (OCPs) in combination with pioglitazone, spironolactone, flutamide, and lifestyle interventions among adolescents aged 11-19 years with PCOS. Literature searches were performed in Medline, Embase, and the Cochrane Central Register of Controlled Trials from database inception through December 2018, with no language restriction. Two reviewers screened titles and abstracts, assessed full text eligibility, and extracted information from eligible trials. Evidence was synthesized through network meta-analyses (NMA) using Bayesian random-effects approach. We identified 37 RCTs, in which 2400 patients were randomized. NMA showed no statistically important difference among all interventions to improve menstrual regulation, or body mass index. Moderate quality evidence showed hirsutism scores were reduced by multiple interventions that included single and combination medications namely; lifestyle intervention, metformin, OCP, spironolactone, pioglitazone, metformin-OCP, metformin-spironolactone, metformin-flutamide, against placebo. Moderate quality evidence showed OCP results in more dysglycaemia compared to metformin (odds ratio 2.98; 95%credible interval 1.02, 8.96), no intervention resulted in dysglycaemia reduction. In conclusion, metformin and OCP as monotherapy or in combination with other interventions compared to placebo can reduce hirsutism scores, but none of these medications lead to effective menstrual cycle regulation or weight reduction. However, the use of OCP leads to worse cardiometabolic risk factors. Further research into new treatment options is urgently needed.

Effects of Fagonia indica on Letrozole-Induced Polycystic Ovarian Syndrome (PCOS) in Young Adult Female Rats

“…Moreover, PCOS is associated with different endocrine, metabolic, and reproductive traits including hyperandrogenism, hyperinsulinism, obesity, hyperlipidemia, type 2 diabetes mellitus, cardiovascular abnormalities, depression, anxiety, anovulation, oligo-ovulation, infertility, hirsutism, and acne [ 3 , 4 ]. This syndrome is so devastated that it can cause endometrial hyperplasia and subsequently the development of endometrial cancer [ 5 ]. Concurrently, the PCOS patients are also suffering from elevated levels of low-density lipoprotein (LDL), triglycerides, total cholesterol, and decreased level of high-density lipoprotein (HDL) [ 6 ].…”

Exploring new treatment options for polycystic ovary syndrome: Review of a novel antidiabetic agent SGLT2 inhibitor

“…Until more research confirms the positive metabolic effect of SGLT-2 inhibitors in PCOS patients, the mainstream treatment option will be lifestyle intervention, metformin, and oral contraceptive pills[ 24 ]. However, this treatment strategy does not successfully address long-term cardiometabolic consequences of PCOS[ 48 ], so SGLT-2 inhibitors, due to their mode of action, emerge as a potential new treatment option for PCOS.…”

Spironolactone Versus Oral Contraceptive Pills in the Treatment of Adolescent Polycystic Ovarian Syndrome: A Systematic Review

“…This was compared to COC (20μg ethinyl estradiol plus 100 mg levonorgestrel), which was seen as effective only in 42% of the adolescents. There are no statistically significant benefits to using SP in menstruation regulation [ 37 ].…”

“…This demonstrates that a low-dose spironolactone combination (SPIOMET) is more effective than COC at reducing dysglycemia. Al Khalifah et al reported dysglycemia outcomes were available for seven therapies across 10 RCTs (n = 639) [ 37 ]. The absolute incidence of dysglycemia was observed to be 57 per 100 patients among COC users (95 % [CI], 1-100 more patients), compared to a baseline risk of 24% among controls.…”

“…The absolute incidence of dysglycemia was observed to be 57 per 100 patients among COC users (95 % [CI], 1-100 more patients), compared to a baseline risk of 24% among controls. There was no statistically significant difference in dysglycemia on using Spironolactone [ 37 ].…”