TY - JOUR
T1 - Adverse effects of the common treatments for polycystic ovary syndrome
T2 - A systematic review and meta-analysis
AU - Domecq, Juan Pablo
AU - Prutsky, Gabriela
AU - Mullan, Rebecca J.
AU - Sundaresh, Vishnu
AU - Wang, Amy T.
AU - Erwin, Patricia J.
AU - Welt, Corrine
AU - Ehrmann, David
AU - Montori, Victor M.
AU - Murad, Mohammad Hassan
PY - 2013/12
Y1 - 2013/12
N2 - Context: Polycystic ovary syndrome (PCOS) is common among women of childbearing age and the available pharmacological therapies have different side-effect profiles. Objective: We summarized the evidence about the side effects of oral contraceptive pills, metformin, and anti-androgens in women with PCOS. Data Source: Sources included Ovid Medline, OVID EMBASE, OVID Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL from inception through April 2011. Study Selection: We included comparative observational studies enrolling women with PCOS who received the agents of choice for at least 6 months and reported adverse effects. Data Extraction: Using a standardized, piloted, and Web-based data extraction form and working in duplicate, we abstracted data from each study and performed meta-analysis when possible. Data Synthesis: We found 22 eligible studies of which 20 were randomized. No study reported severe side effects (eg, lactic acidosis, thromboembolic episodes, liver toxicity, cancer incidence, or pregnancy loss). Meta-analysis demonstrated no significant change in weight in oral contraceptive pills or flutamideusers. Indirect evidencefrompopulations withoutPCOSdemonstratednoincreased risk of lactic acidosis with metformin, only case reports of liver toxicity with flutamide (no comparative evidence), andincreased relative risk differenceofvenousthromboembolismwithoral contraceptive pillsbutvery low absolute risk. Evidence on mortality, cardiovascular mortality, and cancer was inconclusive. Conclusions: Drugs commonly used to treat PCOS appear to be associated with very low risk of severe adverse effects although data are extrapolated from other populations.
AB - Context: Polycystic ovary syndrome (PCOS) is common among women of childbearing age and the available pharmacological therapies have different side-effect profiles. Objective: We summarized the evidence about the side effects of oral contraceptive pills, metformin, and anti-androgens in women with PCOS. Data Source: Sources included Ovid Medline, OVID EMBASE, OVID Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL from inception through April 2011. Study Selection: We included comparative observational studies enrolling women with PCOS who received the agents of choice for at least 6 months and reported adverse effects. Data Extraction: Using a standardized, piloted, and Web-based data extraction form and working in duplicate, we abstracted data from each study and performed meta-analysis when possible. Data Synthesis: We found 22 eligible studies of which 20 were randomized. No study reported severe side effects (eg, lactic acidosis, thromboembolic episodes, liver toxicity, cancer incidence, or pregnancy loss). Meta-analysis demonstrated no significant change in weight in oral contraceptive pills or flutamideusers. Indirect evidencefrompopulations withoutPCOSdemonstratednoincreased risk of lactic acidosis with metformin, only case reports of liver toxicity with flutamide (no comparative evidence), andincreased relative risk differenceofvenousthromboembolismwithoral contraceptive pillsbutvery low absolute risk. Evidence on mortality, cardiovascular mortality, and cancer was inconclusive. Conclusions: Drugs commonly used to treat PCOS appear to be associated with very low risk of severe adverse effects although data are extrapolated from other populations.
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U2 - 10.1210/jc.2013-2374
DO - 10.1210/jc.2013-2374
M3 - Review article
C2 - 24092830
AN - SCOPUS:84889863920
SN - 0021-972X
VL - 98
SP - 4646
EP - 4654
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 12
ER -