Oral and Vaginal Hormonal Contraceptives Induce Similar Unfavorable Metabolic Effects in Women with PCOS: A Randomized Controlled Trial

Maria-Elina Mosorin; Terhi Piltonen; Anni S Rantala; Marika Kangasniemi; Elisa Korhonen; Risto Bloigu; Juha S Tapanainen; Laure Morin-Papunen

doi:10.3390/jcm12082827

Contraception Comparative Studies

Oral and Vaginal Hormonal Contraceptives Induce Similar Unfavorable Metabolic Effects in Women with PCOS: A Randomized Controlled Trial

Mosorin ME, Piltonen T, Rantala AS, Kangasniemi M, Korhonen E, Bloigu R, Tapanainen JS, Morin-Papunen L

Published April 12, 2023 Journal of Clinical Medicine, 12(8), 2827

DOI 10.3390/jcm12082827 PMID 37109164 PMC PMC10143750

RRM Academy Synopsis

Combined Pill and Vaginal Ring Had Similar Metabolic Effects in PCOS

Both contraceptive routes lowered androgen markers and tended to promote insulin resistance in PCOS. A randomized trial in Finland gave 24 women a combined pill or a combined vaginal ring for 9 weeks. In this short trial, the ring did not seem metabolically safer than the pill. PCOS is now also called PMOS (Polyendocrine Metabolic Ovarian Syndrome).

Key Findings

The trial randomized 24 women with PCOS to a combined oral contraceptive (13 women) or a combined vaginal contraceptive ring (11 women), used continuously for 9 weeks.
Sex hormone binding globulin rose in both groups (adjusted p < 0.001 each). The free androgen index fell in both (oral adjusted p < 0.001, vaginal adjusted p = 0.007).
In the vaginal group, glucose at 60 minutes of the glucose tolerance test (adjusted p = 0.011) and the glucose area under the curve (adjusted p = 0.034) increased.
Insulin at 120 minutes rose in both groups (oral adjusted p = 0.004, vaginal adjusted p = 0.042), and fasting insulin rose in the oral group.
Triglycerides (adjusted p < 0.001) and high-sensitivity C-reactive protein, an inflammation marker (adjusted p = 0.040), rose in the vaginal group.

Interpretation

This randomized controlled trial followed 24 women with PCOS in Finland for 9 weeks, comparing a combined pill to a vaginal contraceptive ring. Both routes lowered androgen markers. Both also showed signs of insulin resistance by the end of the trial. The authors note the 9-week trial was too short for solid conclusions on lipid changes, and they describe the metabolic effects overall as mild. The findings support larger studies of both contraceptive routes in women with PCOS.

RRM Context

Restorative reproductive medicine asks why ovulation is irregular in PCOS, and it also evaluates the metabolic features of PCOS. Combined hormonal contraceptives are suppressive medications. The authors say advice on their use in PCOS rests mostly on studies of women without PCOS. An earlier consensus asked for head-to-head trials. This trial adds data on two routes.

Our editorial summary of this paper, not the article's abstract.

Abstract

This clinical trial aims to compare hormonal and metabolic changes after a 9-week continuous use of oral or vaginal combined hormonal contraceptives (CHCs) in women with polycystic ovary syndrome (PCOS). We recruited 24 women with PCOS and randomized them to use either combined oral (COC, n = 13) or vaginal (CVC, n = 11) contraception. At baseline and 9 weeks, blood samples were collected and a 2 h glucose tolerance test (OGTT) was performed to evaluate hormonal and metabolic outcomes. After treatment, serum sex hormone binding globulin (SHBG) levels increased (p < 0.001 for both groups) and the free androgen index (FAI) decreased in both study groups (COC p < 0.001; CVC p = 0.007). OGTT glucose levels at 60 min (p = 0.011) and AUCglucose (p = 0.018) increased in the CVC group. Fasting insulin levels (p = 0.037) increased in the COC group, and insulin levels at 120 min increased in both groups (COC p = 0.004; CVC p = 0.042). There was a significant increase in triglyceride (p < 0.001) and hs-CRP (p = 0.032) levels in the CVC group. Both oral and vaginal CHCs decreased androgenicity and tended to promote insulin resistance in PCOS women. Larger and longer studies are needed to compare the metabolic effects of different administration routes of CHCs on women with PCOS.

Topics

Contraception › Comparative Studies › Contraception Versus Fertility Awareness · Therapeutics › Hormonal Agents › Estrogen Preparations · Reproductive Endocrinology › Ovarian Hormones › Androgens

Maria-Elina Mosorin, Terhi Piltonen, Anni S Rantala, Marika Kangasniemi, Elisa Korhonen, Risto Bloigu, Juha S Tapanainen, Laure Morin-Papunen

M Mosorin, T Piltonen, A Rantala, M Kangasniemi, E Korhonen, R Bloigu, J Tapanainen, L Morin-Papunen

PMID 37109164 37109164 DOI 10.3390/jcm12082827 10.3390/jcm12082827 Mosorin et al. 2023, Mosorin 2023

Oral and Vaginal Hormonal Contraceptives Induce Similar Unfavorable Metabolic Effects in Women with PCOS: A Randomized Controlled Trial

Combined Pill and Vaginal Ring Had Similar Metabolic Effects in PCOS

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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