Review question

Cochrane researchers reviewed the evidence about the effect of ovarian surgery on symptoms of polycystic ovary syndrome (PCOS). We found 22 studies that compared it to surgical and non-surgical treatments, and variations of surgical technique. The main outcomes measured were improvement in the regularity of periods, and a decrease in unwanted hair growth and acne (androgenic symptoms). We also looked at harms from treatment, change in body weight, change in testosterone levels, changes in metabolic measures and quality of life.

Background

Women with PCOS can have a wide range of health problems, including infrequent and irregular periods, unwanted hair growth and acne, and subnormal fertility. Long-term health concerns include an increased risk of heart disease, diabetes and the development of precancerous disease of the womb.

Most of the current research has looked at the effect of ovarian surgery in improving fertility in women with PCOS. Our review aims to look at the impact of laparoscopic (keyhole) ovarian surgery (LOD) on the improvement in the other symptoms of PCOS.

Search date

The evidence is current to October 2016.

Study characteristics

We include 22 randomized controlled trials (RCTs), covering 2278 women. A randomized controlled trial is a type of medical experiment where participants are randomly given one or other different treatments in the study. The participants had PCOS and were from different settings around the world.

Ten out of the 22 RCTs compared LOD to medical treatments. These treatments included metformin, clomiphene, gonadotrophins, letrozole and rosiglitazone. Ten out of 22 studies compared traditional LOD to variations in surgical techniques. Two out of 22 RCTs looked at using different energy levels or number of ovarian drill holes during LOD.

Study funding sources

Two studies reported their funding source (Farquhar 2002 – supported in part by the Auckland Medical Research Foundation; Sarouri 2015 – the authors thank the Vice Chancellor for Research of Guilan University of Medical Sciences for funding this project).

Key results

LOD may be better at regulating menstrual cycles than gonadotrophins. However, most doctors would consider other options for first-line treatment. LOD with four or five drill holes versus two or fewer per ovary may be more effective at menstrual regulation in women with PCOS.

There was not enough evidence to tell whether there is a difference between LOD and other medical treatment or variations in surgical technique in improving the regularity of periods or androgenic symptoms.

LOD was associated with fewer gastrointestinal side effects compared to metformin and clomiphene, but involves surgery and is not standard treatment for menstrual disturbance or unwanted hair growth. There was less scar tissue with transvaginal hydrolaparoscopy compared to LOD.

Overall LOD can be considered to have a low risk of harm, and to be an option in the management of symptoms of PCOS.

Quality of evidence

The quality of the evidence ranged from very low to moderate quality. The main limitations were imprecision associated with the low number of studies, inconsistency and risk of bias associated with the inability to blind participants (conceal the type of treatment from them). There were too few studies to assess risk of publication bias.