Comparison of resumption of ovulation after cessation of oral contraceptives and medroxyprogesterone acetate in women with polycystic ovary syndrome

Abstract

Objective

Both oral contraceptive pills (OCPs) and cyclic medroxyprogesterone acetate (MPA) are widely used to control menstrual abnormalities in women with polycystic ovary syndrome (PCOS). We aimed to evaluate the chance of ovulation resumption after cessation of OCPs and MPA in women with PCOS.

Methods

A retrospective study was conducted of women with PCOS who were treated with OCPs or cyclic MPA from September 2015 to March 2019. After cessation of medication, ovulation was assessed using basal body temperature and/or measurement of serum progesterone. The odds ratio for ovulation resumption was assessed with multivariable logistic regression. Additionally, doubly robust analysis was performed with inverse-probability-weighted analysis and regression adjustment based on the covariate balancing propensity score to adjust for the effect of covariates on the treatment assignment.

Results

Among 272 women with PCOS, 136 were prescribed OCPs and 136 were prescribed cyclic MPA. Ovulation resumed in 18.4% of women (n = 25) after cessation of MPA and in 24.3% of women (n = 33) after cessation of OCPs. The odds of ovulation resumption in MPA users were comparable with those in OCP users (adjusted odds ratio (aOR) 1.00, 95% confidence interval (CI) 0.89–1.12). After multiple imputation due to missing values, the results did not change substantially (aOR 0.99, 95% CI 0.89–1.10).

Conclusions

Among women with PCOS, MPA users have a similar chance of ovulation resumption as OCP users after cessation of medication. Cyclic MPA can be a good alternative to OCPs in women for whom OCPs are contraindicated or who decline to take OCPs.

Keywords:

• Polycystic ovary syndrome
• ovulation
• oral contraceptive pills
• medroxyprogesterone acetate

Author contributions

H.K. contributed to the conception and design. H.K. and S.J.H. collected data. H.K. performed the statistical analyses. H.K. and S.J.H. drafted the manuscript. S.Y.K. and C.S.S contributed to the interpretation of results and editing of the manuscript. All authors read and approved the final manuscript.

Disclosure statement

H.K. has received honoraria for participation on the advisory board of Bayer, and lectures for Roche Diagnostics and Organon, which are unrelated to the subjects addressed in this paper. No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This study was funded by the SNUH Research Fund [grant no. 04-2015-0910]. The funding source had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or decision to submit the paper for publication.