Hormonal Contraceptives
Combined oral contraceptives (COCs) are first-line treatment for acne in
women with PCOS (2, 27). COCs consist of ethinyl estradiol and a
progestational agent, the estrogen suppresses the luteinizing hormone,
increases SHBG, and decreases ovarian androgen production, which
eventually diminishes the free testosterone that is responsible for acne
(29). Certain types of progestins have more potent antiandrogenic
properties and are more effective in treating acne (30).
The commonly used COCPs are desogestrel/ethinylestradiol,
drospirenone/ethinylestradiol, and cyproterone acetate/ ethinylestradiol
(31). However, due to the risk of adverse effects like venous
thromboembolism, cyproterone acetate/ ethinylestradiol must not be
considered as a first-line in PCOS (32).