<b>Objectives:
</b>Irregular menstrual cycles are
associated with increased cardiovascular mortality. Polycystic ovary syndrome
(PCOS) is characterized by androgen excess and irregular menses; androgens are
drivers of increased metabolic risk in women with PCOS. Combined oral
contraceptives (COCPs) are used in PCOS both for cycle regulation and to reduce
the biologically active androgen fraction. We examined COCP use and risk of
dysglycemia (pre-diabetes and type 2 diabetes) in women with PCOS.
<p><b>Research
Design and Methods: </b>Utilizing
a large UK primary care database (The Health Improvement Network, THIN; 3.7
million patients from 787 practices), we carried out a retrospective
population-based cohort study to determine dysglycemia risk (64,051 women with
PCOS, 123,545 matched controls), as well as a nested pharmaco-epidemiological
case-control study to investigate COCP use in relation to dysglycemia risk
(2407 women with PCOS with [=cases] and without [=controls] a diagnosis of
dysglycemia during follow-up).<b> </b>Cox
models were used to estimate the unadjusted and adjusted hazard ratio and
conditional logistic regression was used to obtain adjusted odds ratios
(aORs). </p>
<p><b>Results:
</b>The adjusted hazard ratio for
dysglycemia in women with PCOS was 1.87 (95% CI 1.78-1.97, p<0.001;
adjustment for age, social deprivation, BMI, ethnicity, and smoking), with
increased rates of dysglycemia in all BMI subgroups. Women with PCOS and COCP
use had a reduced dysglycemia risk (aOR 0.72, 95% CI 0.59 to 0.87).</p>
<p><b>Conclusions:
</b>In
this study limited by its retrospective nature and the use of routinely
collected electronic general practice record data, which does not allow to
exclude the impact of prescription-by-indication bias, women<b> </b>with PCOS exposed to COCPs had a reduced risk of dysglycemia across all
BMI subgroups. Future prospective studies should be considered to further
understand these observations and potential causality. </p>
Polycystic Ovary Syndrome, Combined Oral Contraceptives, and the Risk of Dysglycemia: A Population-Based Cohort Study With a Nested Pharmacoepidemiological Case-Control Study
