Combined oral contraceptives (COC) are the most often used treatment modality for
polycystic ovary syndrome (PCOS). Undisputedly, COC suppress
androgen production, thus ameliorating skin androgenic symptoms and improving menstrual dysfunction. On the other hand, there are still many unresolved issues concerning their metabolic effects. COC could decrease
insulin sensitivity and deteriorate
glucose tolerance, although the negative influence on
insulin sensitivity is dependent on other factors (especially
obesity) and this need not be expressed in non-obese patients. It is probable that the impairment of
glucose tolerance is reversible, as the incidence of diabetes is not increased in past COC users. The effects of COC on the
lipid spectrum are dependent on the type of
gestagen, but
lipid levels usually remain within the reference limits. Combination
therapy of COC with
weight reduction or
insulin sensitizers could further suppress
androgen levels and improve metabolic parameters. The establishment of COC after laparoscopic ovarian drilling may further decrease
androgen levels. The combination of COC and
GnRH analogues is not superior to COC
therapy alone. Prospective data about the influence of COC on the risk of
diabetes mellitus,
coronary artery disease and
endometrial cancer in PCOS women are lacking.