Ethinyl estradiol–drospirenone vs ethinyl estradiol–drospirenone plus metformin in the treatment of lean women with polycystic ovary syndrome

Summary Objective Oral contraceptive use might be associated with cardiometabolic risk in PCOS . We aimed to compare the effects of ethinyl estradiol–drospirenone ( EE / DRSP ) alone vs EE / DRSP plus metformin on clinical and cardiometabolic parameters in PCOS . Design Prospective observational study. Patients Forty‐five lean patients with PCOS who received EE / DRSP (30 μg/3 mg) ( n  = 25) or EE / DRSP plus metformin (1700 mg/day) ( n  = 20) and 45 BMI ‐matched healthy controls. Measurement BMI , waist‐to‐hip ratio ( WHR ), hirsutism scores, androgens, lipids, glucose and insulin levels during an OGTT were measured before and after 6 months of treatment in patients and compared to controls. Results At baseline, patients with PCOS showed similar glucose, insulin and lipids but increased 2 h glucose values compared to controls. Hirsutism scores and free androgen index decreased in both treatment groups. BMI and WHR did not show any change in the EE / DRSP group, while metformin addition resulted in a decrease in BMI . Lipid levels increased in both groups. Glucose and insulin parameters did not change in any group, but metformin addition compared to EE / DRSP alone significantly decreased waist circumference, fasting insulin and HOMA ‐ IR . After‐treatment values for both EE / DRSP alone and in combination with metformin compared to the control group showed increased 2 h glucose and increased lipids in patients with PCOS . Conclusion EE / DRSP alone or in combination with metformin improves clinical and biochemical hyperandrogenism in lean PCOS . Both treatments similarly alter lipid profile. EE / DRSP alone does not affect insulin sensitivity, whereas combining EE / DRSP with metformin might improve it.