Combined oral contraceptive pill compared with no medical treatment in the management of polycystic ovary syndrome: a systematic review
Open accessAbstract
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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A recent systematic review by our group found COCP to be effective in improving menstrual cyclicity and hirsutism in PCOS, with limited evidence for hirsutism.
“A recent systematic review by our group found COCP to be effective in improving menstrual cyclicity and hirsutism in PCOS, with limited evidence for hirsutism (13).”
From Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis (2024) · cites this paper as [13]
The Results section reports improved cycle regularity with COCP compared with no treatment, with low certainty of evidence. It does not establish improved hirsutism: the Clinical and biochemical hyperandrogenism results report no difference from placebo or lifestyle, with very low certainty of evidence. Page numbers were not available in our copy. (LLM, conf=0.90)
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Melin, J., Forslund, M., Alesi, S., Piltonen, T., Romualdi, D., Spritzer, P. M., Tay, C. T., Pena, A., Witchel, S. F., Mousa, A., et al. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad465 · Cited by 78 · see citing works
Self-citation
- Authors
- Forslund, M., Melin, J., Alesi, S., Piltonen, T., Romualdi, D., Tay, C. T., Witchel, S., Pena, A., Mousa, A., & Teede, H.
- Affiliations
- Monash University (AU)
- University of Helsinki (FI)
- Oulu University Hospital (FI)
- Agostino Gemelli University Polyclinic (IT)
- Children's Hospital of Pittsburgh (US)
- Discipline of Paedriatics The University of Adelaide and Robinson Research Institute North Adelaide Australia
- Monash Health (AU)
- Corresponding author
- Forslund, Maria
- ORCID
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2023-03-27
- Volume
- 99
- Issue
- 1
- Pages
- 79-91
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- PMC
- PMC10952804
- OpenAlex
- W4327898727
- Cited by
- 32
- References
- 40
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 7 · 2023: 7
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Endocrinology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- Työväentutkimus Vuosikirja (submittedVersion, other-oa)
- Funders
- National Health and Medical Research Council
- Finska Läkaresällskapet
- Orionin Tutkimussäätiö
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- polycystic ovary syndrome, combined oral contraceptives, hirsutism, quality of life, body mass index, weight loss, treatment efficacy
- MeSH terms
- Contraceptives, Oral, Combined, Female, Hirsutism, Humans, Polycystic Ovary Syndrome, Quality of Life
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