Does Vaginal Delivery of Combined Hormonal Contraception Affect the Risk of Metabolic Syndrome in Overweight/obese Women with PCOS

Eligibility Criteria

• * Diagnosis of PCOS according to Rotterdam criteria, with at least 2 of 3 of the following criteria: oligomenorrhea (≤8 periods per year), clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound
• * Body mass index ≥25 and ≤45 kg/m2
• * In good general health according to the investigators' discretion
• * Willing to avoid pregnancy for the duration of the study
• * Current pregnancy or desire for pregnancy during course of study
• * Current breastfeeding
• * Second-trimester pregnancy within four weeks prior to initiation of NuvaRing or third-trimester pregnancy within 6 months prior to initiation of NuvaRing
• * Use of hormonal contraception within four weeks prior to initiation of NuvaRing
• * Diagnosis of metabolic syndrome. Metabolic syndrome will be defined according to the updated Adult Treatment Panel III as 3 or more of the following criteria: blood pressure ≥130/85 mm Hg, waist circumference \>35 inches, fasting glucose ≥110 mg/dL, TG ≥150 mg/dL, HDL-C \<50 mg/dL.
• * Contraindications to NuvaRing use:
• * Age ≥ 35 plus tobacco use
• * Current or past deep vein thrombosis or pulmonary embolism
• * Cerebrovascular disease
• * Coronary artery disease
• * Thrombogenic valvular or rhythm diseases of the heart (such as subacute bacterial endocarditis with valvular disease or atrial fibrillation)
• * Inherited or acquired coagulopathy
• * Headaches with focal neurological symptoms or migraine headaches with aura
• * Age ≥ 35 plus any migraine headaches
• * Liver tumors, benign or malignant
• * Undiagnosed abnormal uterine bleeding
• * Current or past breast cancer or other estrogen- or progestin-sensitive cancer
• * Hypersensitivity to any of the components of NuvaRing
• * Use of hepatitis C drug combinations containing ombitasvir/paritaprevir/ritonavir
• * Medical comorbidities:
• * 21-hydroxylase deficiency, congenital adrenal hyperplasia
• * Untreated thyroid disease
• * Untreated hyperprolactinemia
• * Type 1 or 2 diabetes mellitus
• * Uncontrolled liver disease
• * Uncontrolled renal disease
• * Current alcohol abuse
• * Hypertension ≥ 140 mm Hg average systolic or ≥ 90 mm Hg average diastolic in women using anti-hypertensive medication
• * Hypertension ≥ 150 mm Hg average systolic or ≥ 100 mm Hg average diastolic in women not using anti-hypertensive medication
• * History of or current gynecologic cancer
• * Triglycerides \>=250 mg/dL
• * Current use of lipid-lowering or weight loss agents
• * Participation in any study of an investigational drug or device or biologic agent within 30 days
• * Suspected adrenal or ovarian tumor secreting androgens
• * Suspected Cushing's syndrome
• * Bariatric surgery within 12 months
• * Other medical concerns that in the judgment of the investigator may compromise safety of the participant or confound the reliability of compliance and information acquired in this study