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April 3, 2005
Polycystic ovarian syndrome

Polycystic ovarian syndrome is a poorly understood condition which manifests in a variety of ways that are often cosmetically distressing as well as medically detrimental to the patient.  Patients with PCOS frequently have hirsutism, acne, anovulation and irregular menstruation, and obesity.  They have insulin resistance and are at increased risk for developing diabetes and cardiovascular disease.  Although there are many different approaches to treating patients with PCOS, Metformin is frequently used.  Although the mechanism of action of Metformin is to improve insulin sensitivity, it has been shown that many of the other features of this disorder improve secondary to this effect. 

A small double blind study (n=23) compared patients with PCOS on Metformin vs. placebo over 6 months.  The patients on Metformin had improved insulin sensitivity, more menstrual regularity with more ovulatory cycles, and decreased hyperandrogenism as compared to the placebo group.  Howwever, there was no significant difference in the change in BMI between the 2 groups. 

Another double blind study compared Metformin and antiandrogen medication for the treatment of hirsutism in PCOS.  Both agents were about equally effective in treating hirsutism and acne and the Metformin group also had decreased insulin resistance.

A meta- analysis of 13 studies showed similar results.  Metformin does not appear to help PCOS patients to lose weight but it significantly decreases insulin resistance which is important in the development in DM.  Also, the meta-analysis showed that ovulation occurred much more frequently in patients taking Metformin. 

Although diet and weight loss is very important in the management of PCOS, many of the undesirable affects of this condition appear to be linked to insulin resistance.  Metformin seems to be a good drug to keep in mind for PCOS patients and is helpful in many ways in addition to insulin resistance.

 

Posted At : 5:32 PM. | Link | Rotation 4 04-05 | Comments (6)

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Comments

I had no idea that metformin was used for treating PCOS! Thanks for the good information.

Posted By Taryn Winkle / Posted At 4/3/05 8:40 PM

I think that metformin is an excellent way to treat PCOS because it addresses the idea of insulin resistence and weight control in these patients. The other benefits of the medicine are just icing on the cake.

Posted By George Hoeft / Posted At 4/3/05 9:59 PM

I've seen a couple of patients during this rotation on metformin, both used it for txt of infertility. It's good to know that the drug addresses many other important issues of PCOS as well, particularly as the future pregnancy would present a challenge on metabolic system.

Posted By Dina Kiseleva / Posted At 4/3/05 10:05 PM

Great blog! It brings up the importance of routinely screening for Diabetes in women with polycystic ovary syndrome because of the high prevalence of insulin resistance seen in this population. Although, I haven't seen it in the clinic setting yet, I can see the value of adding Metformin for PCOS therapy.

Posted By Susan Whang / Posted At 4/3/05 10:42 PM

Good information to know. It would be great to use metformin instead of anti-androgen medications that often have unwanted side effects

Posted By Emeka U. Onyedika / Posted At 4/4/05 6:58 PM

This makes good sense. I read that insulin resistance leads to hyperinsulinemia and that this hyperinsulinemia produces the hyperandrogenism of polycystic ovary syndrome by increasing ovarian androgen production. So decrease the insulin resistance, decrease the insulin levels and you improve the PCOS. I had never put the puzzle pieces together before this. thank you for the info.

Posted By Daniel Holbert / Posted At 4/5/05 8:52 AM