Contraceptives plus lifestyle control effective against PCOS effects on glucose, lipid metabolism
Use of oral contraceptive agents in combination with metformin or lifestyle changes appears to effectively reduce the adverse impact of polycystic ovary syndrome (PCOS) on glucose and lipid metabolism in overweight women, according to the results of a network meta-analysis.
The study included 20 trials involving 12 kinds of interventions, as follows: metformin, 2-mg cyproterone acetate plus 0.05-mg ethinylestradiol (EE/CA), 0.15-mg desogestrel plus 0.03-mg ethinylestradiol (EE/DSG), and 3-mg drospirenone plus 0.03-mg ethinylestradiol (EE/DRSP), lifestyle, exercise, diet, metformin + lifestyle, metformin + diet, EE/CA + lifestyle, metformin + EE/CA, and EE/DRSP + lifestyle.
Pooled data showed that some of the interventions produced significant reductions in total cholesterol (TC) levels compared with placebo: metformin + lifestyle (mean difference [MD], –2.04, 95 percent CrI, –3.64 to –0.41), EE/CA + lifestyle (MD, –2.23, –4.11 to –0.35) and EE/DRSP + lifestyle (MD, –2.59, –4.66 to –0.50). On the other hand, the following led to improvements in low-density lipoprotein cholesterol (LDL-C) levels: metformin + lifestyle (MD, –1.82, –2.88 to –0.79), EE/CA + lifestyle (MD, –2.25, –3.58 to –1.08) or EE/DRSP + lifestyle (MD, –2.29, –3.69 to –1.07).
In terms of homeostasis model assessment of insulin resistance (HOMA-IR) and total triglycerides (TG), none of the interventions significantly differed with placebo. However, the surface cumulative rank curve revealed that metformin + lifestyle might be the best intervention with respect to improving HOMA-IR, while EE/DRSP + lifestyle proved to be the most effective for reducing TC and LDL-C. Finally, the metformin + diet intervention trumped all the other interventions for reducing TG levels.
According to the researchers, the present data should provide clinical guidance for the treatment of PCOS. Therefore, large-scale clinical trials are warranted to examine the appropriate dosage of metformin, exercise volume and dietary control.