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WESTPORT, Jan 24 (Reuters Health) - Metformin effectively treats about
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half of women with polycystic ovary syndrome (PCOS), researchers in
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Italy report. Use of the insulin sensitizing agent not only lowers
hyperinsulinemia but may also reduce hyperandrogenemia and reverse
chronic anovulation and menstrual abnormalities.
"Insulin sensitizing agents may prove an efficacious therapeutic tool in
a large subset of subjects with [PCOS]," Dr. Paolo Moghetti and
colleagues at Ospedale Maggiore, in Verona, write in the January issue
of the Journal of Clinical Endocrinology & Metabolism.
In a double-blind trial, the investigators randomized 23 women with PCOS
to receive either metformin 500 mg or placebo three times per day for 6
months. Before the study began, the patients were assessed for insulin
sensitivity, endocrine and metabolic profiles, menstrual history and
serum 17-hydroxyprogesterone response to GnRH-agonist testing. These
tests were also performed at the end of the study.
The study results showed that 50% of women given metformin experienced
"striking amelioration" of menstrual abnormalities, reduced plasma
insulin and increased insulin sensitivity.
The researchers also observed a reduction in ovarian hyperandrogenism,
which was reflected in "...significant reductions in serum free
testosterone and in the 17-hydroxyprogesterone response to GnRH-agonist
testing," they note.
There were no changes in the placebo group, the authors report.
In a follow-on open label trial, 18 of these women plus 14 additional
patients with PCOS were given the same dose of metformin for a mean of
11 months. The objective of the second study were to observe long-term
side effects and determine the baseline predictors of the drug's
efficacy on reproductive abnormalities.
In this trial, 54.8% of women "showed striking improvements" in their
menstrual abnormalities. Additionally, logistic regression analysis
showed that "...plasma insulin, serum androstenedione, and menstrual
history were independent predictors of the treatment's clinical
efficacy."
"The reasons for the striking differences in clinical response to
metformin among the individual PCOS subjects are not easily explained,"
the researchers write. "We hypothesize that this phenomenon might
reflect the heterogeneity in the pathogenesis of the syndrome."
J Clin Endocrinol Metab 2000;85:139-146.
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Thanks,
Bells in Sydney, Australia
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