Different kinds of oral contraceptive pills in polycystic ovary syndrome: a systematic review and meta-analysis

Objective To compare between different combined oral contraceptive pills (COCPs) as part of the update of the International Evidence-Based Guidelines on the Assessment and Management of polycystic ovary syndrome (PCOS). Design A systematic review and meta-analysis was performed, Prospero CRD42022345640. Methods MEDLINE, EMBASE, All EBM, CINAHL, and PsycINFO was searched on July, 8, 2022, for studies including women with PCOS, comparing 2 different COCPs in randomized controlled trials. Results A total of 1660 studies were identified, and 19 randomized controlled trials (RCTs) were included. Fourth-generation COCP resulted in lower body mass index (BMI) (mean difference [MD] 1.17 kg/m(2) [95% confidence interval {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/m(2) [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 venous thrombotic events (VTE) risk in the general population. Later-generation progestins offer theoretical benefits, but better evidence on clinical outcomes is needed in women with PCOS.

Automated summary

This study aimed to compare the efficacy of different combined oral contraceptive pills (COCPs) in the treatment of polycystic ovary syndrome (PCOS). The findings showed that fourth-generation COCPs were effective in reducing body mass index (BMI) and testosterone levels compared to third-generation agents. Ethinyl estradiol (EE)/cyproterone acetate (CPA) was more effective in reducing hirsutism, biochemical hyperandrogenism, and BMI compared to conventional COCPs. However, due to the higher risk of venous thrombotic events (VTE) in the general population, EE/CPA is not recommended as a first-line COCP treatment for PCOS.