Analysis of Intrinsic and Extrinsic Coagulation Pathway Factors in OCP Treated PCOS Women
Oral contraceptive pills (OCPs) are considered a first line treatment option for women with PCOS.
However OCP use is not without any adverse side effects among the general female population with an increased risk of deep vein thrombosis and pulmonary embolism noted.
On the other hand women with PCOS are predisposed to a variety of metabolic consequences and other more serious complications.
For this reason the effect of OCP treatment in women with PCOS warrants special attention.
To evaluate the effect of OCP treatment in PCOS women with particular attention on blood coagulation.
A total of 100 women with PCOS (Rotterdam criteria) was recruited for this observational pilot study.
Women in the treatment group (n=50), receiving Ethinyl estradiol 0.03mg and levonorgestrel 0.1mg for a period of 6 months, was compared to women in a the control group (n=50) who had not received any treatment.
All women underwent anthropometric, biochemical, hormonal, insulin and coagulation profiling.
Blood samples were collected, between the 2nd and 7th day, in the follicular phase following an overnight fast.
Homeostatic model assessment for insulin resistance (HOMA IR), quantitative insulin sensitivity check index (QUICKI) and fasting glucose to insulin ratio (FGIR) were all calculated as per standard formulas.
The mean age of women across both treatment and control groups was similar (24.1 vs. 23.3, P= 0.36).
Anthropometric analysis revealed that OCP treated women had a higher mean weight (63.4 vs. 59.8 kg), BMI (25.9 vs. 24.4 kg/m2), waist (91.4 vs. 87.2 cm) and hip circumferences (98.7 vs. 94.4 cm), but improved hirsutism (8.0 vs. 11.4, FG score) as a result of OCP treatment.
Hormonal analysis also showed that OCP treated women had significantly improved their mean LH (4.1 vs. 8.2 IU/L) and testosterone levels (45.0 vs. 59.6 ng/ml).
On the other hand biochemical analysis revealed that women in the treatment group, had worsened biochemical parameters, including mean glucose fasting results (98.2 vs. 89.7 mg/dl), cholesterol levels (202.1 vs. 171.1 mg/dl) and liver function (SGPT 22.1 vs. 18.0, SGOT 28.3 vs. 25.7 IU/L).
Unsurprisingly fasting insulin levels were also higher in OCP treated women (15.8 vs. 13.7 µIU/ml) causing a deterioration in the HOMA-IR (3.98 vs. 3.06) and QUICKI (0.33 vs. 0.32) results.
Next analysis of pro-coagulation markers showed signifcant dysregulation with increases to Factor V (108.9 vs. 94.6), TAT III complex (8.91 vs. 7.99 ng/ml), tPA (0.96 vs. 0.66 ng/ml) and plasma D-dimer (1.02 vs. 0.52 mg/L).
Overall the authors noted that OCP treatment in women with PCOS may in fact increase the risk of metabolic disorders, such as cardiovascular disease, insulin resistance, type 2 diabetes mellitus and cancer, requiring further studies.
SUMMARY: CAN THE BIRTH CONTROL PILL HELP TREAT PCOS
In this study, use of the COC birth control pill by women with PCOS improved their hormone levels, specifically LH (4.1 vs. 8.2 IU/L) and testosterone (45.0 vs. 59.6 ng/ml), but also had negative effects on anthropometric (weight, waist/hip circumferences), biochemical, insulin and coagulation parameters.
- Observational study
- No baseline measurements pre-treatment
No external funding was declared for this study.
Proportional measurements of the human body.
Measurement of an enzyme or protein in a sample of blood.
A protein fragment produced after a blood clot is broken down by the body.
A protein which helps convert prothrombin into thrombin during the blood clotting process.
Ferriman–Gallwey scale for hirsutism.
Male pattern hair growth.
The probability that a result occurred by random chance.
A condition when one or more arteries in the lungs become blocked by a blood clot.
Serum glutamic oxaloacetic transaminase, an enzyme normally found within the liver or heart cells.
Serum glutamic pyruvic transaminase, an enzyme normally found within the liver or heart cells.
TAT III complex
Thrombin–antithrombin complex, a protein complex of thrombin and antithrombin, which occurs during coagulation.
Tissue plasminogen activator, a protein involved in the breakdown of blood clots.
Dahlgren E, et al. (1998). Effects of two antiandrogen treatments on hirsutism and insulin sensitivity in women with polycystic ovary syndrome. https://doi.org/10.1093/humrep/13.10.2706
Korytkowski M T, et al. (1995). Metabolic effects of oral contraceptives in women with polycystic ovary syndrome. https://doi.org/10.1210/jcem.80.11.7593446
Ovulation disorders are very common and present in 18-25% of couples who see a specialist for infertility treatment. In the general population…. Read more
Polycystic ovary syndrome is a common endocrine condition that affects how a woman’s ovaries work. Described as a low-grade chronic…. Read more