Women with polycystic ovary syndrome (PCOS) have different cholesterol patterns than other women, but some of these differences may actually protect their hearts. Researchers studied 340 women with PCOS and found that while they have some unhealthy cholesterol patterns, their bodies make larger, potentially safer cholesterol particles. However, when women took common PCOS medications—especially birth control pills combined with a hormone-blocking drug—their cholesterol markers changed in ways that might be less healthy. The study suggests doctors should carefully monitor how PCOS treatments affect cholesterol in their patients.

The Quick Take

  • What they studied: How cholesterol and inflammatory markers differ in women with PCOS compared to women without PCOS, and how common PCOS medications change these markers
  • Who participated: 340 women with PCOS and 92 women without high hormone levels (the control group). Researchers also tracked changes in 49 women who took different PCOS medications over time
  • Key finding: Women with PCOS have some unhealthy cholesterol patterns, but they make larger cholesterol particles that may be less harmful to the heart. However, taking birth control pills—especially combined with spironolactone (a hormone-blocking medication)—made cholesterol markers worse compared to taking metformin alone
  • What it means for you: If you have PCOS, your cholesterol profile is different from other women’s, but not necessarily worse for your heart. However, the type of medication you take matters. Talk with your doctor about which PCOS treatment might be best for your heart health, as some medications may have different effects on your cholesterol

The Research Details

This research had two parts. First, researchers compared cholesterol and inflammatory markers in 340 women with PCOS to 92 women without high hormone levels. They measured these markers using a special machine (nuclear magnetic resonance spectroscopy) that can identify different types of cholesterol particles in the blood. Second, they followed 49 women with PCOS who started taking PCOS medications and measured how their cholesterol changed over time. Some women took metformin (a diabetes medication commonly used for PCOS), some took birth control pills, and others took birth control pills combined with spironolactone (a medication that blocks male hormones).

Understanding how PCOS affects cholesterol is important because women with PCOS have higher risk of heart disease. This study goes beyond simple cholesterol numbers to look at the actual particles carrying cholesterol in the blood. Different particles have different effects on heart health, so knowing which particles are present matters more than just knowing total cholesterol numbers. By studying how medications change these particles, doctors can make better choices about which treatments are safest for each patient’s heart.

This study has both strengths and limitations. The strength is the large number of participants (340 women) and the advanced measurement technique that can identify specific types of cholesterol particles. The limitation is that the medication part of the study was smaller (only 49 women) and didn’t randomly assign women to different treatments, so we can’t be completely certain the medications caused the changes. The study was published in a respected medical journal, which means experts reviewed it before publication.

What the Results Show

Women with PCOS had higher levels of VLDL cholesterol (the ‘bad’ cholesterol that carries triglycerides) and lower levels of HDL cholesterol (the ‘good’ cholesterol) compared to women without PCOS. This pattern is typically associated with higher heart disease risk. However, when researchers looked at the actual particles carrying the cholesterol, they found something interesting: women with PCOS had larger HDL particles, which may actually be protective for the heart. They also had larger VLDL particles, which is less harmful than having many small VLDL particles.

When women took medications, all treatments increased inflammatory markers in the blood, which is concerning. However, the birth control pill combined with spironolactone caused larger increases in certain cholesterol particles compared to metformin. Specifically, this combination increased medium and small LDL particles (the harmful type), which could be bad for heart health. Metformin alone had smaller effects on cholesterol particles.

The study found that inflammatory markers (glycoproteins) were higher in obese women, whether or not they had PCOS. This suggests that weight, not PCOS itself, drives inflammation in some cases. The research also showed that different medications had different effects: birth control pills with spironolactone increased more types of cholesterol particles than metformin did. Interestingly, the combination treatment increased small HDL particles, which is generally considered good, but it also increased harmful LDL particles, creating a mixed effect.

Previous research has shown that women with PCOS have unhealthy cholesterol patterns, and this study confirms that finding. However, this research adds new information by showing that the actual particles carrying cholesterol may be different than expected. The finding that larger HDL particles are present in PCOS (which is usually protective) is somewhat surprising and suggests the heart disease risk in PCOS may be more complicated than simple cholesterol numbers indicate. The finding that birth control pills with spironolactone worsen cholesterol particles is important because these medications are commonly prescribed for PCOS.

The study has several important limitations. The medication part only included 49 women, which is a small number, so results may not apply to all women with PCOS. Women weren’t randomly assigned to different medications, so we can’t be completely sure the medications caused the changes—other factors might have played a role. The study measured cholesterol at only one or two time points, so we don’t know how long these changes last. Finally, the study didn’t measure actual heart disease outcomes, only cholesterol markers, so we can’t be certain these changes actually affect heart health in real life.

The Bottom Line

If you have PCOS, ask your doctor about how your cholesterol is being monitored and whether your current medication is the best choice for your heart health. Metformin may have fewer negative effects on cholesterol particles than birth control pills combined with spironolactone, though this needs more research. Regardless of medication choice, maintaining a healthy weight, exercising regularly, and eating a heart-healthy diet are important. Have your cholesterol checked regularly and discuss the results with your doctor. (Confidence level: Moderate—more research is needed before making strong recommendations)

This research is most relevant to women with PCOS who are considering or currently taking medications for their condition. It’s especially important for women concerned about heart disease risk or those with a family history of heart disease. Women who are overweight or obese should pay attention since the study found inflammation is linked to weight. This research is less relevant to women without PCOS or those not taking PCOS medications.

Cholesterol changes from medications typically appear within weeks to months, but the long-term effects on actual heart health take years to develop. You might notice changes in cholesterol test results within 2-3 months of starting a new medication. However, the real question—whether these changes affect your actual risk of heart disease—would take years of follow-up to answer.

Want to Apply This Research?

  • Track your cholesterol levels (total cholesterol, HDL, LDL, and triglycerides) every 3-6 months and log which PCOS medication you’re taking. Note any changes in medication and record the date. This helps you and your doctor see patterns over time.
  • Use the app to set reminders for cholesterol check-ups and to log your PCOS medication daily. Create a heart-health action plan that includes exercise goals (aim for 150 minutes per week), weight management targets if needed, and dietary improvements. Track these behaviors alongside your cholesterol results to see what helps most.
  • Set up quarterly reviews in your app to compare cholesterol results over time and note any medication changes. Create a visual chart showing how your cholesterol markers change with different treatments. Share this data with your doctor at each visit to make informed decisions about your PCOS treatment plan.

This research describes cholesterol patterns in women with PCOS and how medications affect these patterns, but it does not prove that these changes cause heart disease. The study measured cholesterol markers, not actual heart disease outcomes. If you have PCOS or are considering PCOS treatment, discuss these findings with your doctor before making any changes to your medication. Do not stop or start any medication without medical guidance. This information is educational and should not replace professional medical advice.