Comparison of the Effects of Combined Oral Contraceptives Containing Progestins with Low Androgenic and Anti-androgenic Activities on the Clinical, Androgenic, and Metabolic Manifestations of Polycystic Ovary Syndrome

Introduction: Combined oral contraceptives (COCs) are commonly considered as the first-line treatment for polycystic ovary syndrome (PCOS). This study aimed to compare the effects of COCs with respect to their progestin component on the clinical, hormonal, and metabolic outcomes of women with PCOS. Data were extracted by searching PubMed, Scopus, EMBASE, and Google Scholar, without any time limitations (until 2020). All studies assessing the effects of COCs on PCOS patients of childbearing age were reviewed and discussed. Based on the findings, different types of COCs can improve hyperandrogenism and regulate the menstrual cycle by suppressing gonadotropins and increasing sex hormone-binding globulin. Compared to COCs containing androgenic progestins (e.g., desogestrel and levonorgestrel), COCs containing anti-androgenic progestins (e.g., cyproterone acetate and drospirenone) could reduce androgen deprivation through specific mechanisms. However, the available evidence does not support the superiority of these anti-androgenic compounds in improving the clinical manifestations of hyperandrogenism. While all COCs may be associated with lipid disorders, drospirenone-containing compounds seem to be associated with the fewest disorders. Also, as COCs may result in metabolic disorders, especially dyslipidemia, it is necessary to periodically measure metabolic parameters in COC-consuming patients.