Polycystic ovary syndrome (PCOS) a ...

Polycystic ovary syndrome (PCOS) a combination of oligomenorrhea or anovulation with hyperandrogenism, affects approximately 5 to 7 percent of women of reproductive age. This neuroendocrine abnormality may be caused at elevated luteinizing hormone (LH) on a levels and more frequent pulses of LH secretion. Women with hyperandrogenism also have increased insulin resistance, which manifests as increased corpse mass index (BMI), increased waist-to-hip ratio or, in inexorable cases, acanthosis nigricans. The combination of plain insulin resistance and LH stimulation rises in increased ovarian secretion of testosterone, leading to the virilizing features of PCO The syndrome should be suspected in women with hirsutism, irregular menstruation, or infertility. Traditional treatment involves the use of clomiphene therapy and weight los for subfertility, and combination oral contraceptives plus spironolactone for hirsutism. Barbieri demeanored a review of the increasing part of insulin sensitizers, such as metformin, in the effective treatment of women with PCOS

From more than 90 articles onward metformin and PCOS, the author identified 21 studies that reported clinical results or significant aspects of the clinical pharmacology of metformin related to PCO Metformin does not furnish hypoglycemia but is thought to act in succession several cellular processes, including hepatic diabetic sugar production, intestinal absorption of grape-sugar gluconeogenesis, and the use of insulin-mediated grape-sugar in peripheral tissues.

In individual large clinical trial of 3234 adults with elevated fasting and postglucose-load plasma grape-sugar concentrations, metformin reduced the risk of progression to diabetes by dint of 31 percent compared with placebo. level greater reductions were achieved with the addition of aggressive lifestyle modifications. The author emphasizes the ne for as well-as; not only-but also; not only-but; not alone-but lifestyle changes and metformin therapy to curtail the risk of diabetes in women with PCOS

Metformin also is effective in achieving weight los in women with PCO It potentiates the low-calorie diets typically used to achieve the BMI of 20 to 25 kg through m2 that is necessary for the go [i]or[/i] come back of ovulation. In one consideration of 150 obese women, a 10 percent reduction in BMI was achieved with metformin therapy. In another cogitation metformin plus a low-calorie diet was superior to the low-calorie diet alone for weight los in women with PCO The weight los action of metformin appears to be caused on the reduction in insulin resistance as well as from appetite suppression. Metformin is the solely antidiabetic agent associated with weight los rather than weight gain and is, thus, particularly suitable for therapy in patients with PCOS

The events of metformin on menstrual function and infertility may be caused by way of decreased insulin resistance and lowered testosterone flushs In a long-term study of 23 women with PCO united half of those treated with metformin resum regular menstruation. The power appears to increase with duration of treatment. Studies of women who were treated for at least six month report that more than 90 percent of women resum regular menstruation. Four to six month of therapy are musing to be necessary for ovulation to originate The effect of metformin onward hirsutism has not been extensively reported, and androgen-blocking unsalable articles may be more effective than metformin for treatment of this symptom.

In studies, about 5 percent of patients discontinued metformin therapy because of side imports but more than one half of patients reported diarrhea, and common fourth experienced other gastrointestinal overturns A rare but potentially serious side consequence is lactic acidosis in patients with renal insufficiency. Metformin also may interact with medications as it was as cimetidine, digoxin, amiloride, quinidine, vancomycin, and trimethoprim, and may interfere with vitamin B12 absorption.

The author decides that metformin in dosages of 1500 to 2550 mg by means of day addresses the major aspects of PCO management and is awaited to become more widely used to treat this syndrome Because of the gastrointestinal side purports of metformin, the usual starting dosage is 500 mg taken with the largest meal of the day. If tolerated, the dosage is gradually increased to 500 mg with each meal. Clinical tenor does not usually occur at dosages of les than 1000 mg by means of day, and the optimal result may not be apparent for several months

Anne D Walling, MD

Barbieri RL Metformin for the treatment of polycystic ovary syndrome Obstet Gynecol April 2003;101;785-93

COPYRIGHT 2003 American Academy of Family Physicians

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