Which ocp for pcos

Will any form of hormonal birth control work? Combination birth control — whether in the form of a pill, ring, or patch — is the most popular and recommended form of treatment for PCOS.

There are also other alternatives, including: Progesterone therapy: You can take progesterone for 10 to 14 days every one to two months. Metformin: This medication for type 2 diabetes, brand name Glucophage, lowers insulin and androgen levels and improves insulin resistance. Insulin resistance commonly occurs with PCOS, and metformin might be used to treat this. But research has shown that it may help restart ovulation and lead to regular periods. However, a doctor can still use the drug for that purpose.

This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients.

So, your doctor can prescribe a drug however they think is best for your care. Learn more: All about off-label prescription drug use ». Using birth control to protect against pregnancy. Although PCOS is the leading cause of infertility , it affects every woman differently. Some women may become infertile at a young age, and others may find that pregnancy is still possible.

If you decide to use birth control for PCOS management and want to reap the contraceptive benefits, there are a few things you should know. About oral contraceptives On average, the birth control pill is about 91 percent effective at preventing pregnancy. Further well-designed, prospective, long-term, large-scale, randomized clinical trials are also necessary to elucidate the efficacy and safety of metformin or OCPs in the treatment of women with PCOS and appropriately establish the role of these agents in the treatment of PCOS.

In addition, studies regarding management strategies for PCOS patients in the prepubertal and postmenopausal periods are necessary in the near future. National Center for Biotechnology Information , U.

Ther Clin Risk Manag. Published online Sep 1. Author information Copyright and License information Disclaimer.

Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. This article has been cited by other articles in PMC. Methods A literature search of original studies published in PubMed and Scopus was conducted to identify studies comparing metformin with oral contraceptives or evaluating the combination of both in PCOS. Results Eight clinical trials involving patients were examined in the review.

Conclusion The clinical trials suggest that metformin or oral contraceptives are at least patient convenient, efficacious, and safe for the treatment of PCOS. Keywords: polycystic ovary syndrome, metformin, oral contraceptive pill, ovulatory dysfunction, hyperandrogenism, efficacy, safety. Table 1 Diagnostic criteria for polycystic ovary syndrome. Open in a separate window.

Methods A literature search was performed to identify clinical trials in women with PCOS, which evaluated the efficacy and safety of metformin, OCPs, or a combination of both agents. Figure 1. Table 2 Study methods of selected clinical trials of metformin and oral contraceptive pills in treatment of polycystic ovary syndrome. Table 3 Results of selected clinical trials of metformin and oral contraceptive pills in treatment of polycystic ovary syndrome.

Table 4 Reasons for patient discontinuing selected clinical trials of metformin and oral contraceptive pills in treatment of polycystic ovary syndrome. Conclusion The clinical trials reviewed in this study suggest that metformin or OCPs can be at least efficacious and safe patient-convenient medications for the treatment of PCOS at this point. Acknowledgments This study was supported by a research fund from Chosun University, Footnotes Disclosure The authors report no conflicts of interest in this work.

References 1. Adverse effects of the common treatments for polycystic ovary syndrome: a systematic review and meta-analysis. J Clin Endocrinol Metab. Johnson NP. Metformin use in women with polycystic ovary syndrome. Ann Transl Med. Epidemiology, diagnosis, and management of polycystic ovary syndrome.

Clin Epidemiol. Polycystic ovary syndrome: update on diagnosis and treatment. Am J Med. Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome. The Polycystic Ovary Syndrome. Cambridge, MA: Blackwell Scientific; Fertil Steril.

Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline. Pharmacotherapy of polycystic ovary syndrome — an update. Fundam Clin Pharmacol. Peigne M, Dewailly D. The polycystic ovary syndrome: a position statement from the European society of endocrinology. Eur J Endocrinol. Progestins also vary in their androgenicity, and there is substantial evidence linking androgens themselves to insulin resistance.

Androgens have also been shown to lead to the accumulation of visceral fat. Studies on transsexuals by Polderman et al. Given the above, it is likely that the effects of OCPs on carbohydrate metabolism in PCOS will be determined by i the degree of androgenicity of the woman and the androgen-lowering effect of the pill, ii genetically determined endogenous insulin sensitivity, iii anthropometric differences that can affect insulin action and iv the natural history of PCOS or environmental influences.

The latter includes puberty, which is associated with decreased insulin sensitivity Moran et al. A few prismatic studies illustrate these concepts.

Dahlgren et al. Euglycaemic clamp studies were performed before and after treatment. For obvious reasons, there was a marked decrease in free androgens in both groups. However, whereas there was improvement in insulin sensitivity in the GnRH analogue-treated group reduction of both androgens and estrogen , the estradiol—cyproterone-treated group deteriorated the effect of high-dose estrogen in subjects who were already insulin resistant. In another study, Cagnacci et al.

Intravenous and oral glucose tolerance tests were performed. The effect of different progestins of potentially different androgenicity was also illustrated by Ibanez and de Zegher a.

Compared with those who remained on gestodene, the switch to drospirenone was accompanied by a reduction in total and abdominal fat and an increase in lean body mass a less androgenic OCP reduced the abdominal fat and potentially improved the metabolic profile despite the higher dose of estrogen in the drospirenone pill.

Imagine women falling somewhere on an arbitrary scale of insulin sensitivity, at that point in time, ranging from the more sensitive to the most resistant. Four quartiles or groups of PCOS can theoretically emerge. These groups are assigned arbitrarily by the authors to match four categories of responses to OCP, as outlined below.

These individuals have near-normal genetic insulin sensitivity. They are thin, and their only adverse factor is their androgenicity. Treatment with OCP may lead to improvement in carbohydrate metabolism lowering of androgens improved glucose tolerance. These patients have near-normal or mildly impaired genetic insulin sensitivity. They may be of normal weight or mildly overweight.

Their androgenicity is also an adverse factor. Treatment with OCP may show no change in carbohydrate metabolism as the potential impairment of glucose tolerance by the OCP is offset by the androgen-lowering effect of the pill. These individuals may have moderately impaired genetic insulin sensitivity.

They may be moderately overweight. Other adverse factors could include their androgenicity, puberty or the use of an androgenic OCP. The outcome with OCP treatment may be deterioration in carbohydrate metabolism impairment of glucose tolerance by the OCP may be greater than the benefit of the androgen-lowering effect of the pill. These individuals have severely impaired genetic insulin sensitivity. They may be severely obese. Other adverse factors include their androgenicity, puberty or the use of an androgenic OCP.

The outcome of OCP treatment may possibly be the development of frank diabetes. As was illustrated by Doar and Wynn , there is an additive effect of obesity and OCP on the impairment of glucose intolerance or, stated differently, the greater the insulin resistance the worse the effect of the pill.

In the study by Nader et al. A few more prismatic studies will illustrate these concepts. Morin-Papunen and colleagues did two separate studies and on two different groups of PCOS patients. The same cyproterone-containing OCP was used in both groups. Whereas the obese women given the pill had increased glucose AUC during the oral glucose tolerance test, non-obese women given the same OCP had no change in glucose tolerance.

The effect of natural history is well illustrated by Pasquali et al. OCPs were offered at the first visit, but 21 of the 37 subjects never took the pill. Oral glucose tolerance tests were performed initially and at last evaluation. In these 21 subjects, the results indicated an increased insulin AUC consistent with the deterioration in insulin sensitivity.

They had an initial BMI of The other 16 patients took OCPs for an average of 97 months. Their glucose tolerance AUC actually improved, and basal insulin levels declined significantly. However, these individuals had a much lower BMI to begin with: Thus, lowering of androgens and weight loss allowed them to be quartile 1 PCOS. Also, Sabuncu et al. The patients were advised to lose weight and both groups did so, more with the sibutramine.

Oral glucose tolerance tests were performed. As with all COC this medication is contraindicated in patients with hepatic dysfunction, and in those who smoke and those who have a history of coagulopathy, DVT or stroke. Other contraindications for the use of COC also apply to the products containing drospirenone such as carcinoma of the breast or endometrium, and undiagnosed genital bleeding.

Patients over the age of 35 may also be at higher risk or complications such as thrombophlebitis and should be cautioned as such. The use of drospirenone in premenstrual women is not approved.

COCs containing drospirenone are a viable and potentially preferred option for use in the treatment of PCOS and its related symptoms. The efficacy of COCs containing drospirenone as the progestin agent has recently become the topic of much study. Drospirenone has proven to be effective in decreasing hirsutism and testosterone levels and, more significantly, increasing sex hormone binding globulin SHBG levels in women who have PCOS. The pill regimen was followed for six cycles. The 6-month regimen did result in some significant improvements in PCOS symptomatology and hormone levels.

Hirsutism was significantly decreased as demonstrated by a significant decrease in F-G score from baseline. Additionally, testosterone levels decreased significantly and SHBG level increased significantly. These two changes also resulted in a significant decrease in the Free Androgen Index of the enrolled women. Similar to Pehlianov and Mitkov, Guido and colleagues observed a significant decrease in hirsutism as demonstrated by a significant decrease in F-G score. This decrease was not seen by the third cycle but was evident at both the 6th cycle and the 12th cycle.

Guido also noted a significant increase in SHBG at the 3rd cycle, 6th cycle, and 12th cycle. This indicates that the increase in SHBG occurs soon after the administration of the drospirenone-containing COC and that it is a long-lasting rather than transient effect.

A similar study conducted by Batukan and Muderris corroborated these results. Drospirenone-containing COCs were found to significantly increase SHBG levels, significantly decrease testosterone levels, and significantly improve hirsutism after 12 cycles Batukan and Muderris Numerous studies show a decrease in hirsutism within as few as six cycles of drospirenone-containing COCs. Studies have also consistently demonstrated a decrease in testosterone levels within six cycles and an increase in SHBG in as few as six cycles on therapy.

More recently, controversy has arisen over the use of COC in patients with PCOS Nader and Diamanti-Kandarakis specifically regarding the effects of COCs on carbohydrate metabolism and metabolic parameters such as insulin resistance and glucose tolerance Korytkowski et al ; Nader and Diamanti-Kandarakis The most significant change found is a deterioration of insulin sensitivity with the administration of COCs Korytkowski et al ; Dahlgren et al Two studies conducted in obese women with PCOS also showed a decrease in glucose tolerance demonstrated by the results of an oral glucose tolerance test Nader et al ; Morin-Papunen et al However, other studies performed in non-obese women showed no change in glucose tolerance and insulin sensitivity Armstrong et al ; Cibula et al ; Elter et al ; Morin-Papunen et al Triglycerides and HDL cholesterol did increase in both studies however.

The metabolic effects of drospirenone-containing COCs are just beginning to be explored. The European Active Surveillance Study on oral contraceptives followed 58, women for a total of , women years of observation and concluded that the risks of adverse cardiovascular disease and other serious events in users of drospirenone-containing oral contraceptives are similar to those associated with the use of other COCs Dinger et al Because drospirenone is a less androgenic progestin, the metabolic effects appear to be much less severe or entirely non-existent when women with PCOS are treated with drospirenone-containing COCs.

The same study also found that drospirenone-containing COCs appear to have the same effect on lipid levels of PCOS women that they do on healthy controls, which is a major improvement from other COCs. Thus, although the metabolic concerns typical of COC administration in healthy women still exist when drospirenone-containing COCs are used in the treatment of PCOS, the use of drospirenone appears to alleviate the metabolic concerns that are specific to women with PCOS.

National Center for Biotechnology Information , U. Ther Clin Risk Manag. Published online Apr. Author information Copyright and License information Disclaimer. All rights reserved. This article has been cited by other articles in PMC. Keywords: polycystic ovary syndrome, PCOS, oral contraceptives, drospirenone, treatment. Table 1 Clinical manifestations of polycystic ovary syndrome. Menstrual abnormalities including oligo-amenorrhea, polymenorrhea, and dysfunctional uterine bleeding Excess facial and body terminal hair growth, and hirsutism Seborrhea and acne Alopecia Obesity and central visceral fat distribution Acanthosis nigricans and acrochordons Polycystic ovaries.

Open in a separate window. Table 2 Currently available progestins and their androgenic effects. Drospirenone — a progestin with differences Drospirenone, in conjunction with EE, acts to suppress gonadotropins.

Figure 1. Metabolic concerns More recently, controversy has arisen over the use of COC in patients with PCOS Nader and Diamanti-Kandarakis specifically regarding the effects of COCs on carbohydrate metabolism and metabolic parameters such as insulin resistance and glucose tolerance Korytkowski et al ; Nader and Diamanti-Kandarakis