Treating PCOS with a combination of oral contraceptives and spironolactone does not increase the risk of diabetes or heart disease

Sep 2017

In women with polycystic ovary syndrome (PCOS), the most effective treatment is a combination of the oral contraceptive pill (OCP) with an anti-androgen, which does not increase the risk of metabolic or cardiovascular complications, according to a study published in the European Journal of Endocrinology. The findings should lead to more women being prescribed the most effective treatment for their condition.

PCOS is a common condition, affecting approximately 20% of women globally, in which elevated male hormone levels (androgens) can cause a range of distressing and life-limiting symptoms, including reduced fertility, irregular periods, excessive facial and body hair, and acne. There is currently no cure for PCOS, so present treatments aim to manage the symptoms. This has included OCPs, which were an effective treatment for many of the associated symptoms, amongst women not planning to become pregnant. However, during the past two decades, concerns over the increased incidence of insulin resistance and elevated cardiovascular risk factors exhibited by PCOS patients have been partly attributed to the contraceptive-based therapy and resulted in doctors limiting the use of OCPs for PCOS treatment, in favour of insulin sensitiser drugs, such as metformin.

The present study, by researchers at Hospital Universitario Ramón y Cajal and the University of Alcala found no evidence for increased risk of these cardiometabolic complications with the combined treatment of OCP plus the anti-androgen, spironolactone. This suggests that some PCOS patients may have been prescribed alternative, less effective treatments on unwarranted safety fears.

In the study, 46 women with severe PCOS were split into two groups; one group was prescribed the insulin sensitiser, metformin, whilst the other was treated with oral contraceptives plus spironolactone. Over the course of one year the women were assessed on a number of measures that gauged the severity of their PCOS symptoms, metabolic health and cardiovascular risk factors. The researchers found that OCP plus spironolactone was not only more effective in treating PCOS symptoms but was not associated with any increased risk of metabolic or cardiovascular complications. These findings suggest that fears about the safety of OCPs may be unfounded and that combination therapy with an anti-androgen remains the optimal treatment for PCOS. Furthermore, these data suggest that the androgen excess associated with PCOS may contribute to metabolic dysfunction and increased cardiovascular risk factors exhibited by patients, therefore OCP plus and anti-androgen, is more effective at addressing more PCOS symptoms.

Professor Héctor F. Escobar-Morreale said, “According to our present results oral contraceptives plus spironolactone is a much more effective treatment than metformin, showing excellent tolerability and safety, with no increased risk of metabolic dysfunction or cardiovascular risk factors.”

Whilst the combined treatment proved more effective and safe over the course of one year, the longer term effects of OCPs need to be addressed. Ideally, these would be assessed and the present findings could be confirmed and extended in larger, randomised clinical trials. Prof Escobar-Morreale and colleagues are now conducting a meta-analysis of all published data on the use of OCPs, anti-androgens or insulin sensitisers for PCOS treatment, in order to support an evidence-based update to current guidelines on the treatment of PCOS and to ensure patients are receiving the most effective and safest therapy.

Professor Escobar-Morreale stated, “An evidence-based update to the PCOS treatment guidelines could lead to enhanced quality of life and improved long-term outcomes for patients.”


Notes for Editors

The study, “Combined oral contraceptives plus spironolactone compared with metformin in women with polycystic ovary syndrome: a one year randomized clinical trial”, was published in the European Journal of Endocrinology on Friday 15 September 2017. For other press enquiries, or copies of the study, please contact the press office at

European Journal of Endocrinology (EJE) is the official clinical journal of the European Society of Endocrinology, publishing high-quality original research and review articles on all aspects of clinical and translational endocrinology from around the globe. European Journal of Endocrinology is published by Bioscientifica.


Obesity is linked to heavy periods and impaired womb repair
COVID-19 infection may impair fertility in men
Vitamin D levels in the blood can predict future health risks & death
Skin lightening products linked to altered steroid hormone levels
Probiotics may help manage childhood obesity
Ghrelin may be an effective treatment for age-related muscle loss
Evaluating hormone-related targets & risks associated with COVID-19
Thyroid inflammation linked to anxiety disorders
COVID-19 severity is increased in patients with mild obesity
Larger thighs associated with lower risk of heart disease in obesity
Mindfulness helps obese children lose weight
Common anti-inflammatory may increase risk of diabetes
Vitamin B12 deficiency linked to obesity during pregnancy
Impaired liver function during pregnancy may increase risk of childhood obesity
Stress with disrupted body clock increases risk of metabolic disease
New insights into cause and treatments for aggressive form of breast cancer
Age is not a barrier to the benefits of weight-loss surgery
Limiting mealtimes may increase your motivation for exercise
Probiotic supplements may enhance weight loss in obese children
Smoking during pregnancy may damage daughters’ future fertility
Protective effect of breastfeeding on childhood obesity risk linked to leptin gene modification
Men ignore serious health risks of steroid abuse in pursuit of the body beautiful
Sleep problems in teenagers reversed in just one week by limiting screen use
Environmental toxins can impair sexual development and fertility of future generations
Setting fair regulations for top female athletes that have naturally higher testosterone levels
Breastfeeding reduces long-term risk of heart disease in mothers
Obesity risk may be increased by exposure to common environmental chemicals
Mentally tiring work may increase diabetes risk in women
Antioxidants may prevent cognitive impairment in diabetes
Skin inflammation may increase your risk of type-2 diabetes
Debate - Is the gut or the brain more important in regulating appetite and metabolism?
Routine vitamin B12 screening may prevent irreversible nerve damage in type-2 diabetes
Good nutrition could protect children from cognitive difficulties caused by early-life stress
Women more resilient to extreme physical activity than previously reported
Oestrogens in cows’ milk are unlikely to pose a threat to adult health
Diabetic patients are more at risk of death from alcohol, accidents and suicide
Too much vitamin A may increase risk of bone fractures
Vitamin D supplements may promote weight loss in obese children
Vitamin B supplements may protect kidney function in children with diabetes
Bad habits in childhood may lead to an ‘unhealthy’ balance of gut bacteria and increase health risks in later life
Lord Robert Winston cautions that advances in infertility therapies may be hindered by over-regulation
New link identified between inflammation and depression in type-1 diabetes
Walking a tightrope: universal thyroid testing could reduce pregnancy problems in some cases, but interfere with healthy pregnancies in others
Transgender brains are more like their desired gender from an early age
Larger waistlines are linked to higher risk of vitamin D deficiency
Brain stimulation may reduce food cravings as obesity treatment
Minimising exposure to common hormone-disrupting chemicals may reduce obesity rates
Could intermittent fasting diets increase diabetes risk?
Brain development disorders in children linked to common environmental toxin exposures
Children born to mothers with low vitamin D levels may develop autism-like behaviours
Over-the-counter antihistamines linked to impaired fertility in men
Arthritis drug can lower sugar levels in diabetes
Potential new target for reducing osteoporosis risk in men
Successful male infertility treatment does not lower fertility of sons
Warm temperatures can lead to misdiagnosis of diabetes in pregnancy
Guidelines for management of recurrent pituitary tumours recommend new drug as first line treatment
Taking paracetamol during pregnancy may reduce fertility of daughters
Link found between morning sickness, smoking and healthy pregnancies
High fat diet during childhood may increase PCOS risk later in life
Early pregnancy test for cows improves welfare and food production
International collaboration release revised guideline for improved management of Turner syndrome
Treating PCOS with a combination of oral contraceptives and spironolactone does not increase the risk of diabetes or heart disease
Vitamin D supplements could help pain management
Breast cancer risk is more affected by total body fat than abdominal fat
New nanotechnology application for difficult-to-treat cancers
Just six months of frequent exercise improves men’s sperm quality
Consuming more than two soft drinks a day can double risk of diabetes
Age-related scarring in ovaries may explain reproductive decline
Happy cows make more nutritious milk
Third of pregnant women iron deficient; risk thyroid-related pregnancy complications
New recommendations for the diagnosis and treatment of Adrenal Incidentalomas published in the European Journal of Endocrinology
Sitting down for long periods when pregnant linked to weight gain and depression
New drug provides safer alternative to conventional IVF treatment
Enzyme potential target for fight against obesity and diabetes
Bursts of high-intensity exercise could help diabetes patients manage low blood sugar levels
Soybean foods may protect menopausal women against osteoporosis
Vitamin D pill a day may improve exercise performance and lower risk of heart disease
Diabetes associated with increased risk of serious bacterial blood infection
Breast cancer risk higher in women with overactive thyroid
Injection of appetite gene may offer a more effective alternative to dieting
Hyperthyroidism could be great cost to countries in disability benefits
Mother’s hormone levels predict child’s ability to do maths