Effects of combined oral contraceptives on the clinical and biochemical parameters of hyperandrogenism in patients with polycystic ovary syndrome: a systematic review and meta-analysis

Abstract

Introduction: Nowadays, selection of COCs with maximum antiandrogenic effects is one the main issues in treatment of women with polycystic ovary syndrome (PCOS).

Objective: This systematic review and meta-analysis aimed to compare the effects of COCs on the clinical and biochemical parameters of hyperandrogenism (HA) in patients with PCOS.

Methods: Electronic databases (PubMed, Scopus, ScienceDirect and web of science) were searched from 1987 to November 2015 to identify clinical trials investigating effect of the various COCs on the clinical and biochemical parameters of HA in patients. In this meta-analysis, both fixed and random effect models were used. Potential sources of heterogeneity were explored by meta-regression and subgroup analyses.

Results: Findings showed that COC use for 3–12 months was significantly associated with an increase in sex hormone-binding globulin (SHBG) levels and a decrease in Ferriman–Gallwey (FG) score, total testosterone (TT), free testosterone (FT), androstenedione (A4) and dehydroepiandrosterone sulphate (DHEAS) levels. Type of progestin or duration of treatment had no important effects on declining androgen levels. Long-term use of COCs (6–12 months) was more effective in improving hirsutism, compared to short term. COCs containing cyproterone acetate (CPA) for 12 months had the strongest effect in improving hirsutism.

Conclusions: This study shows that, in patients with PCOS, COCs can effectively improve biochemical and clinical parameters of HA. All COCs studies have similar effects on the hormonal profiles of these patients, and products containing CPA may be an effective treatment in hirsute patients with PCOS.

摘要

引言：目前, 选择抗雄激素作用最强的COCs是治疗多囊卵巢综合征(PCOS)的主要问题之一。

目的：这个系统回顾和荟萃分析旨在比较COCs对高雄激素血症（HA）的PCOS的患者的临床和生化指标的影响。

方法：通过检索1987年至2015年11月的PubMed、Scopus、ScienceDirect、web of science等电子数据库, 对不同COCs对HA患者的临床和生化指标的影响进行临床试验研究。本荟萃分析采用固定效应模型和随机效应模型。通过回归分析和小组分析讨论不均一性的潜在来源。

结果：发现应用COC 3-12个月与性激素结合球蛋白（SHBG）水平的升高、FG评分、总睾酮（TT）、游离睾酮（FT）、雄烯二酮(A4)和硫酸脱氢表雄酮(DHEAS)水平的下降显著相关。黄体酮的种类和治疗时间对雄激素水平的下降没有重要影响。与短期应用相比, 长期应用COCs（6-12个月）在改善多毛症状方面更有效。使用含有醋酸环丙孕酮（CPA）的COCs12个月对改善多毛症状的作用最显著。

结论：本研究表明, 在多囊卵巢综合征患者中, COCs可以有效改善HA患者的生化和临床指标。所有的COCs的研究表明对这些患者的激素水平都有类似的影响, 而含有CPA的COCs对有多毛症状的PCOS患者可能是一种有效的治疗方法。

Keywords:

• Meta-analysis
• combined oral contraceptives
• androgens
• hirsutism
• polycystic ovary syndrome

Acknowledgements

The authors wish to acknowledge Ms Niloofar Shiva for critical editing of English grammar and syntax of the manuscript.

Disclosure statement

Authors have no conflict of interest to declare.

Additional information

Funding

This work was supported by Institute of Endocrine Sciences of Shahid Beheshti University of Medical Sciences for approval of this project and its funding as the research project. Registration number: IR.SBMU.ENDOCRINE.RES.1395.222.