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Human Reproduction Update Advance Access originally published online on March 24, 2005
Human Reproduction Update 2005 11(3):277-291; doi:10.1093/humupd/dmi005
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions{at}oupjournals.org

Combined oral contraceptives in the treatment of polycystic ovary syndrome

J. Vrbíková1 and D. Cibula2,3

1 Department of Clinical Endocrinology, Institute of Endocrinology, Narodni 8, Prague 1, 116 94 and 2 Department of Obstetrics and Gynecology, General Faculty Hospital, Charles University, Apolinarska 18, Prague 2, 120 00, Czech Republic

3 To whom correspondence should be addressed. Email: david.cibula{at}iol.cz

Combined oral contraceptives (COC) are the most often used treatment modality for polycystic ovary syndrome (PCOS). Undisputedly, COC suppress androgen production, thus ameliorating skin androgenic symptoms and improving menstrual dysfunction. On the other hand, there are still many unresolved issues concerning their metabolic effects. COC could decrease insulin sensitivity and deteriorate glucose tolerance, although the negative influence on insulin sensitivity is dependent on other factors (especially obesity) and this need not be expressed in non-obese patients. It is probable that the impairment of glucose tolerance is reversible, as the incidence of diabetes is not increased in past COC users. The effects of COC on the lipid spectrum are dependent on the type of gestagen, but lipid levels usually remain within the reference limits. Combination therapy of COC with weight reduction or insulin sensitizers could further suppress androgen levels and improve metabolic parameters. The establishment of COC after laparoscopic ovarian drilling may further decrease androgen levels. The combination of COC and GnRH analogues is not superior to COC therapy alone. Prospective data about the influence of COC on the risk of diabetes mellitus, coronary artery disease and endometrial cancer in PCOS women are lacking.

Key words: antiandrogens / combined oral contraceptives / insulin / laparoscopic ovarian diathermy / polycystic ovary syndrome


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