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Abstract
Introduction: This paper provides a critical review of the data concerning the effects of combined hormonal contraceptives (CHC) for polycystic ovary syndrome (PCOS). The aim is to determine the best treatment option for each PCOS phenotype.
Study design: A literature search of the PubMed database was conducted for randomized clinical trials (RCTs) and observational studies published in any language prior to October 2013. Hyperandrogenism (HA) is the essential diagnostic criterion for PCOS and is frequently associated with insulin resistance (IR) or obesity. The combinations of these criteria define the different PCOS phenotypes and establish the scale of metabolic and cardiovascular risks.
Results and conclusions: 19 RCTs and eight observational studies evaluated issues related to the current objectives. CHC represent an effective and safe treatment in women with any PCOS phenotype. In HA/PCOS patients, any CHC analyzed in this review can be used for symptom relief. For patients with metabolic risk, overweight or moderate IR that does not require metformin, a vaginal contraceptive ring appears to be preferred to oral EE/DRP. In these patients, the combination of CHC and myo-inositol may be more effective in controlling endocrine and metabolic profiles. However, further research is needed to define the optimal duration and to clarify the effects of treatment on long-term metabolic outcomes. Future research should also focus on new CHC.
Chinese abstract
引言：这篇文章将复合激素类口服避孕药对多囊卵巢综合征（polycystic ovary syndrome，PCOS）患者作用的相关数据进行了重要的综述，目的是为PCOS不同表型患者提供最好的治疗方法。
研究设计：对PubMed 数据库2013年10月前以任何语言发表的随机临床试验（randomized clinical trials，RCTs）和观察性研究进行文献检索。雄激素增多症是PCOS的主要诊断且常常与胰岛素抵抗或肥胖相关。这些标准的组合定义了不同的PCOS表型，建立代谢和心血管疾病风险的模式。
结果和结论：我们检索到19项RCTs和8项观察性研究。复合激素类避孕药对任何表型的PCOS患者都有好的有效性和安全性。这篇综述中分析到的任何一种激素类避孕药都能改善高雄型PCOS患者的症状。有代谢风险、超重或中度胰岛素抵抗不需应用二甲双胍的PCOS患者，阴道避孕环比口服雌孕激素作用要好。对于这些患者复合激素避孕药和肌醇联合应用可能会更好的控制内分泌和代谢问题。但需要进一步研究来确定最合适的应用时间及长期治疗对代谢结局的影响。将来的研究还应关注新型复合激素避孕药。