Oral contraceptive reduces risk of diabetes in women with polycystic ovary syndrome

Use of combined oral contraceptives appears to significantly reduce the risk of type 2 diabetes in women with polycystic ovary syndrome (PCOS).

Researchers reported this finding on Oct. 14, 2021 in Diabetes Care.

Co-senior author Professor Wiebke Arlt, Director of the University of Birmingham’s (UK) Institute of Metabolism and Systems Research, said, “We knew from previous, smaller studies, that women with PCOS have an increased risk of type 2 diabetes.  However, what is important about our research is that we have been able to provide new evidence from a very large population-based study to show for the very first time that we have a potential treatment option – combined oral contraceptives – to prevent this very serious health risk.”

As background, the authors noted that irregular menstrual cycles are linked with increased cardiovascular mortality, and that  polycystic ovary syndrome (PCOS) is characterized by androgen excess and irregular menses. Likewise, androgen excess increases metabolic risk in women with PCOS. Clinicians use combination oral contraceptive pills (COCPs) in PCOS for menstrual cycle regulation and to reduce androgen excess.

Using UK patient GP records of 64,051 women with PCOS and 123,545 matched control women without PCOS, the investigators analyzed the data to discern the comparative risk of type 2 diabetes and pre-diabetes among these subjects.

They reported that women with PCOS had a doubled risk of manifesting type 2 diabetes or pre-diabetes, compared to those without PCOS.

To investigate the impact of the COPS pill on development of type 2 diabetes or pre-diabetes, the researchers conducted a further nested case control study of 4,814 women with PCOS. They found that use of combined oral contraceptives reduced the risk of developing type 2 diabetes and pre-diabetes by 26% in women with PCOS.

Co-senior author Krish Nirantharakumar, Professor in Health Data Science and Public Health at the University of Birmingham’s Institute of Applied Health Research, added: “Importantly, our data highlight that normal weight women with PCOS were also at increased risk of type 2 diabetes and pre-diabetes. This parallels our previous finding of increased NAFLD [non-alcoholic fatty liver disease] risk in normal weight women with PCOS, further challenging the notion that PCOS-related metabolic complications are only relevant in the context of obesity. These data suggest that, rather than obesity in isolation, PCOS-specific factors, including androgen excess, underpin the increased metabolic risk.”

Joint first author Anuradhaa Subramanian, research associate at the University of Birmingham, added, “With one in 10 women living with PCOS, which is a life-long metabolic disorder, it is incredibly important that we find ways of reducing its associated health risks.”