title: Hormonal contraceptive choice for women with PCOS: a systematic review of randomized trials and observational studies.
abstract: BACKGROUND
  This paper provides a critical review of the data concerning the effects of combined hormonal contraceptives (CHC) for polycystic ovary syndrome (PCOS). The aim is to determine the best treatment option for each PCOS phenotype.
  
  
  METHODS
  A literature search of the PubMed database was conducted for randomized clinical trials (RCTs) and observational studies published in any language prior to October 2013. Hyperandrogenism (HA) is the essential diagnostic criterion for PCOS and is frequently associated with insulin resistance (IR) or obesity. The combinations of these criteria define the different PCOS phenotypes and establish the scale of metabolic and cardiovascular risks.
  
  
  CONCLUSIONS
  19 RCTs and eight observational studies evaluated issues related to the current objectives. CHC represent an effective and safe treatment in women with any PCOS phenotype. In HA/PCOS patients, any CHC analyzed in this review can be used for symptom relief. For patients with metabolic risk, overweight or moderate IR that does not require metformin, a vaginal contraceptive ring appears to be preferred to oral EE/DRP. In these patients, the combination of CHC and myo-inositol may be more effective in controlling endocrine and metabolic profiles. However, further research is needed to define the optimal duration and to clarify the effects of treatment on long-term metabolic outcomes. Future research should also focus on new CHC.
authors.affiliation: a Departamento de Obstetricia y Ginecología, Universidad de Granada Granada Spain.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mendoza
authors.affiliation: b Dipartimento di Medicina Clinica e Sperimentale, Div. Ginecologia e Ostetricia, Università di Pisa Pisa Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Simoncini
authors.affiliation: c Clinica Ostetrica Ginecologica, University of Modena Modena Italy.
authors.forename: Alessandro D
authors.initials: AD
authors.lastname: Genazzani
mesh_terms: D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use*; D003657:Decision Making; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications / Q000188:drug therapy*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D003278:Contraceptives, Oral, Hormonal
keywords: Hirsutism; hormonal contraception; ovary; polycystic ovary syndrome