University of Oulu

Forslund, M, Melin, J, Alesi, S, et al. Combined oral contraceptive pill compared with no medical treatment in the management of polycystic ovary syndrome: a systematic review. Clin Endocrinol (Oxf). 2023; 99: 79-91. doi:10.1111/cen.14913

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

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Author: Forslund, Maria1,2; Melin, Johanna2,3; Alesi, Simon2;
Organizations: 1Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2Monash Centre for Health Research & Implementation, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victori, Australia
3Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
4Department of Obstetrics and Gynecology, Research Unit of Clinical Medicine and Medical research Centre, Oulu University Hospital, University of Oulu, Oulu, Finland
5Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
6Department of Pediatrics, Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
7Discipline of Paedriatics, The University of Adelaide and Robinson Research Institute, North Adelaide, Australia
8Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Victoria, Australia
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
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Language: English
Published: John Wiley & Sons, 2023
Publish Date: 2023-11-06


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.

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Series: Clinical endocrinology
ISSN: 0300-0664
ISSN-E: 1365-2265
ISSN-L: 0300-0664
Volume: 99
Issue: 1
Pages: 79 - 91
DOI: 10.1111/cen.14913
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3123 Gynaecology and paediatrics
Funding: M. F. received funding from the Iris foundation. J. M. received funding from The Medical Society of Finland and Orion Research Foundation. A. M. is supported by a biomedical research fellowship provided by the National Health and Medical Research Council (NHMRC) of Australia. S. A. is supported by a Monash University Faculty Graduate Scholarship University. H. T. is an NHMRC Medical Research Future Fund Practitioner Fellow.
Copyright information: © 2023 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.