American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line therapy for managing heavy menstrual bleeding in women with polycystic ovary syndrome?

1. Progestin-only contraceptives

2. Metformin

3. Estrogen-progestin oral contraceptive pills

4. GnRH agonists

The correct answer is: Estrogen-progestin oral contraceptive pills

The first-line therapy for managing heavy menstrual bleeding in women with polycystic ovary syndrome (PCOS) is indeed the use of estrogen-progestin oral contraceptive pills. This approach addresses both the heavy menstrual bleeding and the hormonal imbalance commonly seen in PCOS. Estrogen-progestin combination pills work by stabilizing the endometrial lining, thereby reducing excessive bleeding. They also help regulate menstrual cycles, which can often be irregular in women with PCOS due to ovulatory dysfunction. The contraceptive effects of these pills can also be beneficial because they provide birth control for sexually active women who may not be seeking pregnancy. Furthermore, hormone therapy through these pills can alleviate other symptoms of PCOS, such as hirsutism and acne, due to the anti-androgenic properties of certain progestins used in conjunction with estrogen. In contrast, while progestin-only contraceptives may help reduce some aspects of heavy menstrual bleeding, they are often less effective than the combination pills in regulating cycles and controlling symptoms. Metformin, primarily used for glycemic control in insulin-resistant patients, does not directly address heavy menstrual bleeding. GnRH agonists can be effective but are typically not first-line due to their potential side effects and are