Combined oral contraceptive use and adiposity in women with polycystic ovary syndrome. A meta-analysis of randomized clinical trials

Abstract

Background. Combined oral contraceptives (COCs) are of first line treatment of women with polycystic ovary syndrome (PCOS) who do not intend to become pregnant. PCOS is a heterogeneous condition with subphenotypes with different risks for future development of cardiovascular disease. The combination of COC and PCOS may or may not amplify the risks of cardiovascular events. Objective. To investigate whether surrogates for adiposity may be influenced by the use of COCs with different formulations in women with PCOS. Method. A literature search was conduct in Google Scholar and Pubmed databases. Hand search of randomized clinical trials in the references of obtained manuscripts was also performed. The search identified 3820 articles and 13 randomized clinical trials in which was possible to compare the results obtained before and after the use of COCs. Random-effects model was used to estimate the standardized mean differences (SMD) and standard erros (SE). Risk of bias was examined using the Rob2 tool. Result. Thirteen heterogeneous RCTs reported no difference on waist circumference with the use of different COC formulations (p = 0.714). On the contray, body fat mass increased with the use of pill (p = 0.013). Anthropometric-metabolic biomarkers waist triglyceride index and visceral adiposity index did not change but the lipid accumulation product tended to be higher after use of COCs. Conclusion. Combined oral contraceptives with different formulations might increase fat mass accumulation in women with PCOS. Lipids may also be accumulated in the PCOS users.