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).