Laura “Eli” Moreno, MD Ashley Bonnell, PharmD Jon O. Neher, MD Valley Family Medicine Residency, Renton, Wash
Sarah Safranek, MLIS University of Washington Health Sciences Library, Seattle
DEPUTY EDITOR Gary Kelsberg, MD Valley Family Medicine Residency, Renton, Wash
Statins alone don’t affect hirsutism, menstruation, or BMI
A Cochrane review identified 4 RCTs (244 women, ages 18-39 years) that compared a statin alone with placebo, another agent, or another agent plus a statin.9 One RCT of 48 patients found that a statin combined with an OCP improved hirsutism compared with a statin alone. Two RCTs (85 patients) found that statins didn’t lead to resumption of regular menstrual cycles. Statins also didn’t alter BMI in 3 studies of 105 patients.
Trials report no adverse effects, but VTE may be a concern with OCPs
A meta-analysis evaluated the safety of metformin, OCPs, and antiandrogens in 22 clinical trials with 1335 patients, primarily PCOS patients. The trials reported no cases of lactic acidosis with metformin, no drug-induced liver injury with antiandrogens, and no venous thromboembolism (VTE) with OCPs. The meta-analysis authors noted, however, that in a cohort trial of 1.6 million Danish women followed for 15 years, OCPs were associated with a 2- to 3-fold increase in risk of VTE, with higher risks linked to higher ethinyl estradiol content.10
A 2009 practice bulletin from The American College of Obestetrics and Gynecology (ACOG) recommends OCPs, progestin, metformin, and TZDs for anovulation and amenorrhea in patients with PCOS. OCPs, antiandrogens, metformin, eflornithine, and mechanical hair removal are recommended for hirsutism. ACOG advocates LSM, insulin-sensitizing agents (such as metformin), and statins to prevent cardiovascular disease and diabetes.11