A bitter pill to swallow: adjustments to oral contraceptive pill use in polycystic ovary syndrome

ABSTRACT

Introduction

This Special Report aims to highlight the importance of tailored therapies in women with Polycystic Ovary Syndrome (PCOS), avoiding prescribing generalized or unsuitable therapies based on oral contraceptive pills (OCPs).

Areas covered

This article discusses the benefits and risks of OCP-based therapy, highlighting the possible undesirable effects, especially in those patients exhibiting risk factors as women with PCOS, and the importance of carefully evaluated tailored therapeutic approaches. Literature searches were performed with the use of PubMed, Google Scholar, and Web of Science between January and February 2024.

Expert opinion

Considering the recent re-analysis of PCOS Rotterdam Criteria by the Expert Group on Inositol in Basic and Clinical Research, and on PCOS (EGOI-PCOS), the traditional Rotterdam phenotypes can be reclassified to achieve more efficacious therapy choices. Using personalized therapies that consider the specific clinical characteristics of the patient allows to improve the management of the syndrome, thus avoiding the generalized use of OCPs, which risk treating only symptoms of PCOS rather than the underlying cause. In cases when contraceptive purpose is desired, patients may benefit from combined therapy with diet or insulin-sensitizer agents, as inositol, to rebalance the metabolic profile, thus reducing the risk of developing future complications.

KEYWORDS:

• Oral contraceptive pills
• polycystic ovary syndrome
• metabolic alterations
• phenotypes
• diagnosis
• tailored therapies
• inositol

Article highlights

• Combined hormonal contraceptives are widely used worldwide among young women for birth control, but their use may expose them to different undesirable side effects.

• The use of OCPs requires a revision, notably to take into account the patient’s clinical background.

• A large portion of patients with PCOS exhibit metabolic and/or inflammatory alterations that expose them to a higher risk of complications when treated with OCPs.

• In the incidence of OCP treatment for contraceptive purposes in PCOS patients, a combined OCP + inositol approach may represent a safer strategy.

• Patients with PCOS require a specific diagnosis with a defined phenotype, which is mirrored in the therapy choice.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.