Combined Oral Contraceptive Pill and Resistance Starch

Inclusion criteria

• Women between ages of 18-40 years with BMI greater than or equal to 25 kg/m² to less than or equal to 48 kg/m² diagnosed with PCOS defined by the Rotterdam criteria based on a history of chronic anovulation (8 or fewer periods), androgen excess [defined as total serum testosterone, free testosterone or a FAI greater than or equal to 90% of the upper limit of normal) or hirsutism (Ferriman-Gallwey score greater than 6 for Hispanics/ Black and greater than or equal to 2 for women of Asian descent)] and polycystic ovaries as defined by a pelvic ultrasound (20 or more follicles or ovarian vol greater than 10cm3) or elevated AMH.
• For women with more regular bleeding patterns, but who are suspected to be experiencing periodic anovulatory bleeding, a midluteal progesterone (P4) level less than 3ng/dL will be evidence of ovulatory dysfunction and qualify as anovulation.
• Women with only hyperandrogenic PCOS phenotype (hyperandrogenism + one more criteria) will be included to decrease the heterogeneity of the cohort and as metabolic risks are increased in these women compared to normo-androgenic women with PCOS.
• Subjects should be willing to avoid pregnancy for the entire duration of the study.

Exclusion criteria

• Subjects with other causes for irregular menses such as pregnancy, lactation, untreated hypothyroidism, untreated hyperprolactinemia and premature menopause.
• Subjects with late onset adrenal hyperplasia
• Subjects with history of bariatric surgery
• Those who are unable to comply with the study procedures, for instance due to mental illness, substance abuse, or participation in other studies.
• Subjects taking medications that affect weight or metabolic parameters (e.g. lipid lowering medications).
• History of Crohn's disease and ulcerative colitis as well as current use of probiotics and laxatives are excluded.
• Subjects could not have taken antibiotics for at least 3 months prior to randomization visit.
• Subjects with greater than 20 g/day of dietary fiber intake based on pre-screening ASA-24 survey will be excluded.
• Subjects with medical conditions that are contraindications to use of OCP and other medical conditions such as:

• Type 1 or 2 diabetes
• liver disease or dysfunctional liver (AST/ALT greater than 2x normal or a total bilirubin greater than 2.5 mg/dL)
• renal disease (BUN greater than 30 mg/dL or serum creatinine greater than 1.4 mg/dL)
• severe anemia (hemoglobin less than 10 mg/dL)
• alcohol abuse
• poorly controlled hypertension
• TG greater than 250 mg/dl
• chronic inflammatory conditions such as psoriasis
• history of deep venous thrombosis, pulmonary embolus, or cerebrovascular accident; known heart disease (New York Heart Association Class II or higher)
• history of cervical carcinoma, endometrial carcinoma, or breast carcinoma, adrenal or ovarian tumor secreting androgens, and Cushing's syndrome -