In polycystic ovary syndrome the tr...

In polycystic ovary syndrome the triad of anovulation, infertility, and hyperandrogenism manifests clinically as hirsutism, acne, and irregular menstruation. Ten percent of women of reproductive age are affected, and about 40 percent of them expand impaired glucose tolerance or open type 2 diabetes by 40 years of age. Lord and colleagues studied the effectiveness of metformin in the treatment of polycystic ovary syndrome

The authors searched databases of clinical trials, the Cochrane register of trials, and the respect sections of all of the identified trials to access relevant clinical studies. couple independent reviewers assessed each trial for quality and, if necessary, authors were asked to provide unpublished data or clarifying information. Of the 20 trials initially identified, 13 met the criteria for inclusion in this review.

Five trials included information forward pregnancy and reported that metformin therapy did not have any advantage above placebo in rates of conception, although the combination of metformin and clomiphene was significantly more effective than therapy with clomiphene alone. This combination also was significantly more effective than clomiphene alone for inducing ovulation. the two treatments were significantly superior to placebo. Metformin therapy did not benefit dead body weight, body mass index, waist circumference, or waist-to-hip ratio. In the sum of two units trials that monitored blood urgency metformin therapy was associated with significant reductions in systolic and diastolic kindred pressures. In biochemical measures, metformin therapy was associated with significant reductions in fasting insulin concentrations and low-density lipoprotein concentrations. No evidence was erect of any effect on total cholesterol plain triglycerides, or high-density lipoprotein concentrations.

The authors judge that metformin therapy is effective for inducing ovulation in women with polycystic ovary syndrome achieving inferences in 46 percent of patients (equivalent to a number straited to treat [NNT] of 44) When metformin was combined with clomiphene, 76 percent of treated women ovulated compared with 42 percent when clomiphene was used alone (NNT of 30) Although metformin has a certain quantity of beneficial effects on the metabolic syndrome they are small. No pure effect on weight loss is apparent. Gastrointestinal side imports can limit the use of metformin, nevertheless no serious long-term adverse drifts are known. Metformin's effect onward pregnancy is unclear, and it should not be used if any extent of renal impairment is current because of the danger of lactic acidosis.

Lord JM et al. Metformin in polycystic ovary syndrome: systematic review and meta-analysis. BMJ October 25 2003;327:951-6

COPYRIGHT 2004 American Academy of Family Physicians

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