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

• Published in: Clinical endocrinology (Oxford) Vol. 99; no. 1; pp. 79 - 91
• Main Authors: Forslund, Maria, Melin, Johanna, Alesi, Simon, Piltonen, Terhi, Romualdi, Daniela, Tay, Chau Thien, Witchel, Selma, Pena, Alexia, Mousa, Aya, Teede, Helena
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.07.2023; John Wiley and Sons Inc
• Subjects: androgen excess; anxiety; Body mass index; cancer; combined oral contraceptive pills; Contraceptives, Oral, Combined - therapeutic use; Endocrinology & Metabolism; endometrial; Female; Hirsutism; Hirsutism - drug therapy; Humans; hyperandrogenism; irregular cycles; Medical treatment; Meta-analysis; metformin; Obstetrics, Gynecology and Reproductive Medicine; Oral contraceptives; Original; Ovaries; Polycystic ovary syndrome; Polycystic Ovary Syndrome - drug therapy; prevalence; Quality of Life; randomized controlled-trial; Reproduktionsmedicin och gynekologi; risk; sample; Systematic review; treatment; women; treatment; hyperandrogenism; irregular cycles; combined oral contraceptive pills; polycystic ovary syndrome
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/cen.14913

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.