Comparing the Effects of Combined Oral Contraceptives Containing Progestins With Low Androgenic and Antiandrogenic Activities on the Hypothalamic-Pituitary-Gonadal Axis in Patients With Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials and nonrandomized studies
PubMed 29695378 · doi:10.2196/resprot.9024
What was done
Authors conducted a systematic review and meta-analysis across PubMed, Scopus, Google Scholar, ScienceDirect, and Web of Science (1980–2017) comparing the effects of combined oral contraceptives (COCs) containing low androgenic and antiandrogenic progestins (cyproterone acetate, drospirenone, and desogestrel) on the hypothalamic-pituitary-gonadal axis in patients with polycystic ovary syndrome (PCOS). Both randomized controlled trials and nonrandomized studies were included. Weighted mean differences (WMD) were calculated using fixed- and random-effects models for FSH, LH, LH-to-FSH ratio, estradiol, total testosterone, and sex hormone-binding globulin (SHBG) across 3, 6, and 12 months.
What was found
Cyproterone acetate COCs significantly decreased FSH at 3 months (WMD = -0.48; 95% CI, -0.81 to -0.15), 6 months (WMD = -2.33; 95% CI, -3.48 to -1.18), and 12 months (WMD = -4.70; 95% CI, -4.98 to -4.42), and decreased LH at 3 months (WMD = -3.57; 95% CI, -5.14 to -1.99), 6 months (WMD = -5.68; 95% CI, -9.57 to -1.80), and 12 months (WMD = -11.60; 95% CI, -17.60 to -5.60), as well as significantly decreasing estradiol. Drospirenone COCs at 6 months reduced FSH (WMD = -0.93; 95% CI, -1.79 to -0.08) and LH (WMD = -4.59; 95% CI, -7.53 to -1.66), with no significant effect on estradiol. Desogestrel data were few and showed no statistically significant influence on gonadotropins. No COC significantly changed the LH-to-FSH ratio. All COCs had comparable effects on total testosterone and SHBG, unaffected by progestin type or treatment duration.
Why it matters
Cyproterone acetate-containing contraceptives achieve the strongest suppression of gonadotropins and estradiol, but alternative progestins like drospirenone provide comparable improvements in androgenic markers in PCOS.
Limits
The total number of included studies and overall participant sample size are not reported in the abstract. Inclusion of nonrandomized studies alongside randomized trials introduces risk of bias. Data for desogestrel-containing COCs were sparse, and clinical endpoints (such as hirsutism scores or metabolic outcomes) were not reported.
Cited by
- supports Birth control pills stimulate sex hormone-binding globulin (SHBG) production, which binds circulating testosterone and helps relieve symptoms of PCOS.