Estroprogestins and cardiovascular risk in Polycystic Ovary Syndrome

Because PCOS women present an increased cardiovascular risk, the safety of estroprogestin treatment is debated and contrasting data have been reported. However, cardiovascular risk is not the same in all PCOS women and individual cardiovascular risk should be assessed before staring any estroprogestin treatment. The available data show that products containing both second generation and third generation progestins (including drosperinone and cyproterone acetate) represent a safe treatment in PCOS patients with regular cardiovascular risk. In PCOS patients with increased cardiovascular risk, a careful choice of estroprogestin product is needed and cardiovascular risk should be monitored during treatment. In obese PCOS patients with normal glucose tolerance and lipid profile, products containing second generation progestins may be preferred because lower VTE risk. In PCOS patients with altered lipid profile or glucose intolerance, third generation progestins should be used but, during treatment, cardiovascular risk should be periodically reassessed. In special situations, metformin or statins may be added to estroprogestin treatment.