Spironolactone Versus Oral Contraceptive Pills in the Treatment of Adolescent Polycystic Ovarian Syndrome: A Systematic Review

Abstract

Polycystic ovarian syndrome (PCOS) is a multi-system endocrinopathy that affects women of reproductive age. Due to features that coincide with puberty, it frequently remains undiagnosed in adolescent females. The lack of evidence on management alternatives has resulted in significant variation in practice. This systematic review evaluated the therapeutic advantages and adverse effects of a regularly used therapy option, combined oral contraceptive pills (COC/OCP) with spironolactone (SP), a newer alternative that may be used alone or in conjunction with other drugs to treat adolescent PCOS. A literature search was conducted using PubMed, PubMed Central, Scopus, and Google Scholar. It was restricted to studies published in English between 2021 and 2011 that discussed the management of adolescent PCOS with COC, SP, or both. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Two reviewers independently examined the content of the included studies using appropriate quality assessment tools. Four meta-analyses, four randomized controlled trials (RCTs), and one traditional review were found to be eligible. After extensive analysis, we concluded that SP, alone or in combination, is far safer than COC. However, COC treats more PCOS-associated symptoms than SP, including acne and menstrual irregularities, while also providing contraceptive benefits. However, SP monotherapy is cardioprotective and therapeutic when combined with other drugs. Long-term COC use has been linked to an increased risk of venous thromboembolism, hypertension, dyslipidemia, low-density lipoprotein (LDL) elevation, dysglycemia, and cancer in women.

Keywords: adolescent; adolescent pcos; coc; combined oral contraceptive pills; ocp; oral contraceptive pills; pcos; polycystic ovarian syndrome; spiomet; spironolactone.

Figure 1. Pathophysiology of PCOS

FSH: follicular stimulating hormone; LH: luteinising hormone; SHBG: sex hormone-binding globulin; T2DM: type 2 diabetes mellitus; E1: estrone; E2: estradiol; IGF1: insulin-like growth factor 1; PCOS: polycystic ovarian syndrome. Created with BioRender.com by the authors.

Figure 2. PRISMA 2020 flow diagram

PRISMA: Preferred reporting items for systematic reviews and meta-analysis. The figure was created by the authors.