Birth Control Pills Show Mixed Effects on PCOS

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Birth control pills show mixed effects on PCOS

Analysis of Intrinsic and Extrinsic Coagulation Pathway Factors in OCP Treated PCOS Women

doi.org/10.1007/s12291-020-00901-w

Background

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.

Aim

To evaluate the effect of OCP treatment in PCOS women with particular attention on blood coagulation.

Methodology

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.

Results

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.

Limitations

  1. Observational study
  2. No baseline measurements pre-treatment

Funding

No external funding was declared for this study.

Glossary

Anthropometric
Proportional measurements of the human body.

Biochemical
Measurement of an enzyme or protein in a sample of blood.

D-dimer
A protein fragment produced after a blood clot is broken down by the body.

Factor V
A protein which helps convert prothrombin into thrombin during the blood clotting process.

FG
Ferriman–Gallwey scale for hirsutism.

Hirsutism
Male pattern hair growth.

n
Sample size.

P-value
The probability that a result occurred by random chance.

Pulmonary embolism
A condition when one or more arteries in the lungs become blocked by a blood clot.

SG0T
Serum glutamic oxaloacetic transaminase, an enzyme normally found within the liver or heart cells.

SGPT
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.

tPA
Tissue plasminogen activator, a protein involved in the breakdown of blood clots.

Similar studies

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


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