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Oral contraceptives associated with worsening lipid profile in PCOS
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In women with polycystic ovary syndrome, the use of any oral contraceptive was associated with a rise in triglyceride and total cholesterol levels over time, and oral contraceptives containing third-generation progestins did not offer substantial advantages, according to findings from a systematic review and meta-analysis.
“While in the general population, oral contraceptive use is considered safe with only a modest risk of venous thromboembolism, it is unclear whether the same rule applies to PCOS patients, many of whom present some relative contraindications to the use of [oral contraceptives], [including] being obese, insulin-resistant and/or with altered glucose tolerance or dyslipidemia,” Mina Amiri, a PhD student in the department of reproductive health and midwifery at Shahid Beheshti University of Medical Sciences in Tehran, Iran, and colleagues wrote. “In fact, some studies have raised concern regarding the potential adverse cardiovascular and metabolic effects of [oral contraceptives] in women with PCOS, suggesting worsening of insulin resistance and glucose tolerance, and potential adverse effects on lipid patterns.”
Amiri and colleagues analyzed data from 831 women with PCOS and without diabetes or other chronic diseases participating in 26 studies (34 treatment groups) investigating the effects of oral contraceptives on the metabolic profiles of women with PCOS (mean age, 23 years). Included studies took place between 2001 and 2015; all had follow-up times of at least 3 months, but no more than 24 months. Researchers assessed BMI, fasting blood glucose, fasting insulin, homeostatic model of insulin resistance (HOMA-IR), triglycerides, total cholesterol, LDL cholesterol, HDL cholesterol, and systolic and diastolic blood pressure. Researchers compared treatment groups of studies and estimated weighted mean differences using primary pooled effect analysis.
Ethinyl estradiol was the estrogenic component in all included studies; progestin components included desogestrel, cyproterone acetate and drospirenone.
Researchers found that all studied oral contraceptives showed similar effects on lipid profiles but with different timings. Oral contraceptives containing cyproterone acetate raised HDL levels at 6 months, with the elevated levels confirmed in more prolonged treatment (12 months). After 6 months of treatment, oral contraceptives containing ethinyl estradiol and drospirenone increased triglyceride levels (mean difference, 18.22; 95% CI, 6.3-30.13), with higher levels persisting at 12 months. Oral contraceptives containing drospirenone or desogestrel increased HDL cholesterol at 3 months, whereas all oral contraceptives increased HDL cholesterol at 6 months, with results persisting at 12 months. All studied oral contraceptives increased LDL cholesterol at 12 months of use, according to researchers.
Researchers observed no changes in other metabolic outcomes for women with PCOS using oral contraceptives; researchers observed a “mild” decrease in BMI after 6 months with ethinyl estradiol and drospirenone, but not after prolonged treatment. Prolonged treatment (12 months) with oral contraceptives containing ethinyl estradiol and desogestrel or ethinyl estradiol and drospirenone revealed increased insulin levels; pooled mean differences were 2.35 (95% CI, 1.33-3.37) and 3.45 (95% CI, 0.25-6.64), respectively.
“This systematic review and meta-analysis demonstrated that products containing third-generation progestins do not offer significant advantages on products containing [cyproterone acetate],” the researchers wrote. “Instead, the clinician should be aware of all possible deleterious effects of all [oral contraceptives] on lipid profiles of PCOS women and, hence, periodically assess the lipid values of these women.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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