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

Figures & data

Table 1 Eligibility criteria of the World Health Organization

Category	Eligibility	Use of the method
1	A condition for which there is no restriction for the use of the contraceptive method	Yes
2	A condition where the advantages of using the method generally outweigh the theoretical or proven risks	Yes
3	A condition where the theoretical or proven risks usually outweigh the advantages of using the method	No
4	A condition which represents an unacceptable health risk if the contraceptive method is used.	No

Note: Reprinted from Medical eligibility criteria for contraceptive use, Fifth edition, World Health Organization, 1–267, Copyright 2015. Available from: http://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/.¹³

Figure 1 Flowchart for contraceptive choice for PCOS women.

^*Note: Any CHC, although preference should be given to those containing ethinylestradiol.

Abbreviations: CHC, combined hormonal contraceptive; CU-IUD, cupper intrauterine device; PCOS, polycystic ovary syndrome; POC, progestogen-only contraceptive.

Table 2 Medical eligibility criteria for hormonal contraceptive use in women with SAH

	COC/RING/PATCH	CIC	POP	DMPA	ENG/LNG IMPLANTS	LNG-IUS
Controlled SAH	3	3	1	2	1	1
Uncontrolled SAH (mmHg)
140–159×90–99	3	3	1	2	1	1
≥160×≥100	4	4	2	3	2	2
Vascular disease	4	4	2	3	2	2

Note: Reprinted from Medical eligibility criteria for contraceptive use, Fifth edition, World Health Organization, 1–267, Copyright 2015. Available from: http://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/.¹³

Abbreviations: CIC, combined injectable contraceptive; COC, combined oral contraceptive; DMPA, depot medroxyprogesterone acetate; ENG, etonogestrel; LNG, levonorgestrel; LNG-IUS, levonorgestrel-releasing intrauterine system; POP, progestogen-only pill; SAH, systemic arterial hypertension.

Table 3 Medical eligibility criteria for hormonal contraceptive use in women with dyslipidemia

	COC/RING/PATCH	CIC	POP	DMPA	ENG/LNG IMPLANTS	LNG-IUS
Dyslipidemia with no other risk factors	2	2	2	2	2	2
Dyslipidemia with other risk factors	3/4	3/4	2	3	2	2

Note: Reprinted from Medical eligibility criteria for contraceptive use, Fifth edition, World Health Organization, 1–267, Copyright 2015. Available from: http://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/.¹³

Abbreviations: CIC, combined injectable contraceptive; COC, combined oral contraceptive; DMPA, depot medroxyprogesterone acetate; ENG, etonogestrel; LNG, levonorgestrel; LNG-IUS, levonorgestrel-releasing intrauterine system; POP, progestogen-only pill.

Table 4 Medical eligibility criteria for hormonal contraceptive use in women with diabetes mellitus (DM) associated or not with vasculopathy

	COC/RING/PATCH	CIC	POP	DMPA	ENG/LNG IMPLANTS	LNG-IUS
DM (regardless of insulin use)
Nonvascular disease	2	2	2	2	2	2
Nephropathy, retinopathy, neuropathy, or another vascular disease or diabetes of >20 years duration	3/4	3/4	2	3	2	2

Note: Reprinted from Medical eligibility criteria for contraceptive use, Fifth edition, World Health Organization, 1–267, Copyright 2015. Available from: http://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/.¹³

Abbreviations: CIC, combined injectable contraceptive; COC, combined oral contraceptive; DM, diabetes mellitus; DMPA, depot medroxyprogesterone acetate; ENG, etonogestrel; LNG, levonorgestrel; LNG-IUS, levonorgestrel-releasing intrauterine system; POP, progestogen-only pill.

Table 5 Medical eligibility criteria for hormonal contraceptive use in obese women without any other cardiovascular risk factors

	COC/RING/PATCH	CIC	POP	DMPA	ENG/LNG IMPLANTS	LNG-IUS
Obesity	2	2	1	1/2	1	1

Note: Reprinted from Medical eligibility criteria for contraceptive use, Fifth edition, World Health Organization, 1–267, Copyright 2015. Available from: http://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/.¹³

Abbreviations: CIC, combined injectable contraceptive; COC, combined oral contraceptive; DMPA, depot medroxyprogesterone acetate; ENG, etonogestrel; LNG, levonorgestrel; LNG-IUS, levonorgestrel-releasing intrauterine system; POP, progestogen-only pill.

Table 6 Medical eligibility criteria for hormonal contraceptive use in women with MeTS

	COC/RING/PATCH	CIC	POP	DMPA	ENG/LNG IMPLANTS	LNG-IUS
MeTS	3/4	3/4	2	3	2	2

Note: Reprinted from Medical eligibility criteria for contraceptive use, Fifth edition, World Health Organization, 1–267, Copyright 2015. Available from: http://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/.¹³

Abbreviations: CIC, combined injectable contraceptive; COC, combined oral contraceptive; DMPA, depot medroxyprogesterone acetate; ENG, etonogestrel; LNG, levonorgestrel; LNG-IUS, levonorgestrel-releasing intrauterine system; MeTS, metabolic syndrome; POP, progestogen-only pill.

Table 7 Medical eligibility criteria for hormonal contraceptive use in women with a history of arterial or venous thrombosis

	COC/RING/PATCH	CIC	POP	DMPA	ENG/LNG IMPLANTS	LNG-IUS
Personal history of DVT/PE or thrombophilia	4	4	2	2	2	2
History of stroke or ischemic heart disease	4	4	2/3*	3	2/3*	2/3*

Notes: Reprinted from Medical eligibility criteria for contraceptive use, Fifth edition, World Health Organization, 1–267, Copyright 2015. Available from: http://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/.¹³

* If the ischemic episode occurred during the use of POC (POP, implant, and LNG-IUS), the method is defined as category 3; if the patient has a personal history of ischemic heart disease and the event occurred before the use of POC, the method is defined as category 2 and can be started.

Abbreviations: CIC, combined injectable contraceptive; COC, combined oral contraceptive; DMPA, depot medroxyprogesterone acetate; DVT/PE, deep venous thrombosis/pulmonary embolism; ENG, etonogestrel; LNG, levonorgestrel; LNG-IUS, levonorgestrel-releasing intrauterine system; POC, progestogen-only contraceptive; POP, progestogen-only pill.

Table 8 Summary of medical eligibility criteria for hormonal contraceptive use in women with comorbidities related to polycystic ovary syndrome

	COC/RING/PATCH	CIC	POP	DMPA	ENG/LNG IMPLANTS	LNG-IUS
Controlled SAH	3	3	1	2	1	1
Uncontrolled SAH (mmHg) or vascular disease
140–159×90–99	3	3	1	2	1	1
≥160×≥100	4	4	2	3	2	2
MeTS	4	4	2	3	2	2
Dyslipidemia with no other risk factors	2	2	2	2	2	2
Dyslipidemia with other risk factors	3/4	3/4	2	3	2	2
DM (regardless of insulin use)
Nonvascular disease	2	2	2	2	2	2
Nephropathy, retinopathy, neuropathy, or another vascular disease or diabetes of >20 years of duration	3/4	3/4	2	3	2	2
Obesity	2	2	1	1/2	1	1
Personal history of DVT/PE or thrombophilia	4	4	2	2	2	2
History of stroke or ischemic heart disease	4	4	2/3*	3	2/3*	2/3*

Notes: Reprinted from Medical eligibility criteria for contraceptive use, Fifth edition, World Health Organization, 1–267, Copyright 2015. Available from: http://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/.¹³

* If the ischemic episode occurred during the use of POC (POP, implant, and LNG-IUS), the method is defined as category 3; if the patient has a personal history of ischemic heart disease and the event occurred before the use of POC, the method is defined as category 2 and can be started.

Abbreviations: CIC, combined injectable contraceptive; COC, combined oral contraceptive; DM, diabetes mellitus; DMPA, depot medroxyprogesterone acetate; DVT/PE, deep venous thrombosis/pulmonary embolism; ENG, etonogestrel; LNG, levonorgestrel; LNG-IUS, levonorgestrel-releasing intrauterine system; MeTS, metabolic syndrome; POC, progestogen-only contraceptive; POP, progestogen-only pill; SAH, systemic arterial hypertension; POC, progestogen-only contraceptive.

World Health OrganizationMedical Eligibility Criteria for Contraceptive Use5th edGenevaWorld Health Organization2015 Available from: http://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/

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