Efficacy of Treatments for Polycystic Ovarian Syndrome Management in Adolescents

Reem A Al Khalifah; Ivan D Florez; Michael J Zoratti; Brittany Dennis; Lehana Thabane; Ereny Bassilious

doi:10.1210/jendso/bvaa155

Efficacy of Treatments for Polycystic Ovarian Syndrome Management in Adolescents

J Endocr Soc. 2020 Oct 17;5(1):bvaa155. doi: 10.1210/jendso/bvaa155. eCollection 2021 Jan 1.

Authors

Reem A Al Khalifah^{1

2}, Ivan D Florez^{2

3}, Michael J Zoratti², Brittany Dennis^{2

4}, Lehana Thabane^{2

5

6}, Ereny Bassilious⁷

Affiliations

¹ Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
² Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
³ Department of Pediatrics, Universidad de Antioquia, Medellín, Colombia.
⁴ Department of medicine, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
⁶ Department of Pediatrics and Anesthesia, McMaster University, Hamilton, Ontario, Canada.
⁷ Department of Pediatrics, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada.

Abstract

Limited evidence on treatment options for polycystic ovarian syndrome (PCOS) has led to considerable variation in health care practices. We aimed to compare the effects of metformin and/or oral contraceptive pills (OCP) in combination with pioglitazone, spironolactone, flutamide, and lifestyle interventions among adolescents aged 11 to 19 years with PCOS. Literature searches were performed in Medline, Embase, and the Cochrane Central Register of Controlled Trials from database inception through December 2018, with no language restriction. Two reviewers screened titles and abstracts, assessed full text eligibility, and extracted information from eligible trials. Evidence was synthesized through network meta-analyses (NMA) using a Bayesian random-effects approach. We identified 37 randomized controlled trials, in which 2400 patients were randomized. NMA showed no statistically important difference among all interventions to improve menstrual regulation or body mass index. Moderate-quality evidence showed hirsutism scores were reduced by multiple interventions that included single and combination medications namely; lifestyle intervention, metformin, OCP, spironolactone, pioglitazone, metformin-OCP, metformin-spironolactone, and metformin-flutamide against placebo. Moderate-quality evidence showed OCP results in more dysglycemia compared to metformin (odds ratio, 2.98; 95% credible interval, 1.02-8.96), no intervention resulted in dysglycemia reduction. In conclusion, metformin and OCP as monotherapy or in combination with other interventions compared with placebo can reduce hirsutism scores, but none of these medications lead to effective menstrual cycle regulation or weight reduction. However, the use of OCP leads to worse cardiometabolic risk factors. Further research into new treatment options is urgently needed.

Prospero registration number: CRD42015016148.

Keywords: adolescents; cardiometabolic; hirsutism; menstrual irregularity; network meta-analysis; polycystic ovarian syndrome.

Publication types

Review