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Hormonal contraception in women with polycystic ovary syndrome: choices, challenges, and noncontraceptive benefits

Authors de Melo AS, Reis RM, Ferriani RA, Vieira CS

Received 5 December 2015

Accepted for publication 9 April 2016

Published 2 February 2017 Volume 2017:8 Pages 13—23

DOI https://doi.org/10.2147/OAJC.S85543

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Igal Wolman


Anderson Sanches de Melo, Rosana Maria dos Reis, Rui Alberto Ferriani, Carolina Sales Vieira

Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil

Abstract: Polycystic ovary syndrome (PCOS) is an endocrine disorder among women of reproductive age characterized by chronic anovulation and polycystic ovary morphology and/or hyperandrogenism. Management of clinical manifestations of PCOS, such as menstrual irregularities and hyperandrogenism symptoms, includes lifestyle changes and combined hormonal contraceptives (CHCs). CHCs contain estrogen that exerts antiandrogenic ­properties by triggering the hepatic synthesis of sex hormone-binding globulin that reduces the free testosterone levels. Moreover, the progestogen present in CHCs and in progestogen-only ­contraceptives suppresses luteinizing hormone secretion. In addition, some types of progestogens directly antagonize the effects of androgens on their receptor and also reduce the activity of the 5α reductase enzyme. However, PCOS is related to clinical and metabolic comorbidities that may limit the prescription of CHCs. Clinicians should be aware of risk factors, such as age, smoking, obesity, diabetes, systemic arterial hypertension, dyslipidemia, and a personal or family history, of a venous thromboembolic event or thrombophilia. This article reports a narrative review of the available evidence of the safety of hormonal contraceptives in women with PCOS. Considerations are made for the possible impact of hormonal contraceptives on endocrine, metabolic, and cardiovascular health.

Keywords: polycystic ovary syndrome, hormonal contraceptive, lipid metabolism, carbohydrate metabolism, hyperandrogenism, thrombosis

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