Different kinds of oral contraceptive pills in polycystic ovary syndrome: A systematic review and meta-analysis
Abstract
OBJECTIVE
To compare between different combined oral contraceptive pills (COCP) as part of the update of the International Evidence-Based Guidelines on Assessment and Management of polycystic ovary syndrome (PCOS).
DESIGN
Systematic review and meta-analysis, Prospero CRD42022345640.
METHODS
MEDLINE, EMBASE, All EBM, CINAHL and PsycINFO was searched on July 8th, 2022 for studies including women with PCOS, comparing two different COCPs in randomized controlled trials.
RESULTS
1660 studies were identified,19 RCTs were included.Fourth-generation COCP resulted in lower BMI (MD 1.17 kg/m2 (95% CI 0.33; 2.02) and testosterone (MD 0.60 nmol/L (95% CI 0.13; 1.07) compared with third-generation agents, but no difference was seen in hirsutism.Ethinyl estradiol (EE)/cyproterone acetate (CPA) was better in reducing hirsutism as well as biochemical hyperandrogenism (testosterone MD 0.38 nmol/L (95%CI 0.33-0.43)) and BMI MD 0.62 kg/m2 (95% CI 0.05-1.20) compared with conventional COCPs.There was no difference in hirsutism between high and low EE doses. No evidence regarding natural estrogens in COCP was identified.
CONCLUSION
With current evidence, combined regimens containing an antiandrogen (EE/CPA) may be better compared with conventional COCPs in reducing hyperandrogenism, but EE/CPA will not be recommended as a first line COCP treatment by the pending PCOS guideline update, due to higher VTE risk in the general population. Later generation progestins offer theoretical benefits, but…
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