Effect of Oral Contraceptive Pill and Metformin on Metabolic and Endocrine Parameters in Polycystic Ovarian Syndrome: A Prospective Interventional Study

Abstract

Introduction: Polycystic Ovarian Syndrome (PCOS) is one of the most common endocrinopathies, affecting women of reproductive age group worldwide. There is no comprehensive data, regarding the outcome of various treatment modalities. Aim: To assess the effect of Oral Contraceptive Pills (OCP) and metformin on metabolic and endocrine parameters in PCOS. Materials and Methods: It was a prospective interventional study, done over a period of 12 months from January 2017 to January 2018 at the Outpatient Department (OPD) of Gynaecology and Obstetrics, Medical College, Kolkata. A total of 162 PCOS patients were recruited. The selected patients were divided into two groups A and B, based on the clinician’s assessment with respect to the patient profile. Group A received lifestyle intervention plus metformin (started at 500 mg / day and according to patient’s response and the clinical judgement titrated upto 2000 mg/day for 6 months) and group B received lifestyle intervention plus oral contraceptive pill. (fixed dose combination of ethinyl estradiol 50 micrograms and cyproterone acetate 2 milligrams per day for 6 months). The patients were assessed for metabolic parameters [Fasting Blood Sugar (FBS), Post-Prandial Blood Sugar (PPBS), Haemoglobin A1C (HbA1C), lipid profile] and endocrine parameters [testosterone, prolactin and Thyroid Stimulating Hormone (TSH)]. The Student t-test, Chisquare test and Analysis of Variance (ANOVA) test were used to compare the data. Results: A total of 162 patients were recruited for the present study with the mean age in group A was 23.75±1.7 and in group B was 22.40±1.6 years. The mean HbA1C levels of group A before the initiation of the treatment was found to be 7.51±0.89% which was reduced to 7.45±0.49% and 6.83±0.34% at the end of two months and six months respectively (p-value=0.001). In group B, serum testosterone was significantly reduced from 2.86±0.48 to 2.18±0.42 (p-value=0.0001), however the glycemic control worsened. Conclusion: OCPs and metformin do not significantly correct metabolic abnormalities associated with PCOS, although, gynecological symptoms are improved significantly. Comparatively, metformin helps in control of blood sugar levels but high BMI and deranged lipid profile remains unaltered by both metformin and OCP.