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Yes, there is a relatively new treatment for PCOS - (polycystic ovary syndrome). In PCOS cause the recently discovered relationship between PCOS and insulin resistance has been presented. Metformin is a drug that increases sensitivity to insulin and it therefore reverses the insulin resistance of PCOS. Metformin has been used since the 1950s in the treatment of diabetes. There is accumulating evidence that metformin has a significant part to play in the treatment of PCOS, whether the symptoms are amenorrhoea (absent periods), oligomenorrhoea (infrequent periods), obesity, hirsutism (excessive hair production) or anovulation (failure to release eggs resulting in infertility). Metformin 500mg tablets are taken two or three times daily after meals. Although metformin has been available for more than forty years, its application for PCOS is new and it has yet to be licensed for this indication. We therefore provide metformin for PCOS only with informed consent (informed consent). Some women may be initially troubled by bowel disturbance and flatulence but these problems improve after a couple of weeks. The tablets can be split into two. We have found that if patients are having a lot of problems it may be worth taking only half a tablet daily for a few days and gradually increasing the dose over two or three weeks. At this time there is no substitute for metformin as a drug to increase insulin sensitivity but there is a new class of insulin-sensitising agents due to be launched soon the thiazolidinedionesIt will be some years before the true value of metformin for patients with PCOS will be determined. Initial experience has shown that it is beneficial for women with hirsutism and absent or infrequent periods and infertility. It may assist in weight reduction. There is theoretical reason for optimism that metformin prescribed for women with PCOS will have several long-term benefits. It has been suggested that metformin may reduce complications which may occur with ovulation stimulation particularly with gonadotrophin injections:
A thirty-five year old woman had stopped seeing her periods (amenorrhoea) for a year and her weight had been increasing. Her only other problem was IBS (Q23.34). Her BMI was 38 (Q9.8) showing that her weight was 50% greater than it should have been. Ultrasound examination of her pelvis showed no abnormality and in particular there was no suggestion of polycystic ovaries. Her LH was 8.4 IU/l and FSH 4.8 IU/l which are normal readings and her thyroid tests and prolactin were normal. The testosterone was 3.2 nmol/l which is towards the upper level of normal but her SHBG was low at 14 nmol/l. Her fasting blood sugar was 4.8 mmol/l (normal) but her fasting insulin was 18.7 mU/L which is high. Metformin was commenced.
This case is an example of a patient presenting with two problems that can be associated with polycystic ovary syndrome namely amenorrhoea and obesity although the ultrasound was reported as showing normal ovaries. Her LH was not high and even her testosterone was just within the normal range. The low SHBG is a strong pointer to the diagnosis. Although the high fasting insulin in this case seems reassuring that metformin is likely to prove beneficial the value of insulin tests in clinical management remains to be determined.
Related Medical Abstracts - Click on the paper title:-
- Metformin versus oral contraceptive pill in polycystic ovary syndrome: a Cochrane review. (2007-01)
- Insulin-sensitising drugs versus the combined oral contraceptive pill for hirsutism, acne and risk of diabetes, cardiovascular disease, and endometrial cancer in polycystic ovary syndrome. (2007-02)
- Polycystic ovary syndrome in adolescents: current and future treatment options. (2006-01)
- Polycystic ovarian syndrome--prognosis and outcomes. (2006-02)
- Treatment with flutamide, metformin, and their combination added to a hypocaloric diet in overweight-obese women with polycystic ovary syndrome: a randomized, 12-month, placebo-controlled study. (2006-03)
- Metformin treatment is effective in obese teenage girls with PCOS. (2006-04)
- The effect of metformin on fat distribution and the metabolic syndrome in women with polycystic ovary syndrome--a randomised, double-blind, placebo-controlled trial. (2006-05)
- Metformin therapy improves coronary microvascular function in patients with polycystic ovary syndrome and insulin resistance. (2006-06)
- Metformin treatment of polycystic ovary syndrome improves health-related quality-of-life, emotional distress and sexuality. (2006-07)
- Prevention of diabetes and cardiovascular disease in women with PCOS: treatment with insulin sensitizers. (2006-08)
- Insulin-sensitizing agents in polycystic ovary syndrome. (2006-09)
- Indices of low-grade chronic inflammation in polycystic ovary syndrome and the beneficial effect of metformin. (2006-10)
- Metformin-diet ameliorates coronary heart disease risk factors and facilitates resumption of regular menses in adolescents with polycystic ovary syndrome. (2006-11)
- Lipids in polycystic ovary syndrome: role of hyperinsulinemia and effects of metformin. (2006-12)
- Metformin versus rosiglitazone in the treatment of polycystic ovary syndrome. (2006-13)
- Randomized placebo-controlled trial of metformin for adolescents with polycystic ovary syndrome. (2006-14)
- Early effects of metformin in women with polycystic ovary syndrome: a prospective randomized, double-blind, placebo-controlled trial. (2006-15)
- Metformin as treatment for overweight and obese adults: a systematic review. (2005-01)
- Insulin resistance in polycystic ovarian disease. (2005-02)
- Metformin and weight loss in obese women with polycystic ovary syndrome: comparison of doses. (2005-03)
- Randomized controlled trial evaluating response to metformin versus standard therapy in the treatment of adolescents with polycystic ovary syndrome. (2005-04)
- Polycystic ovarian syndrome: marked differences between endocrinologists and gynaecologists in diagnosis and management. (2005-05)
- Effects of metformin and ethinyl estradiol-cyproterone acetate on lipid levels in obese and non-obese women with polycystic ovary syndrome. (2005-06)
- Combined use of metformin and ethinyl estradiol-cyproterone acetate in polycystic ovary syndrome. (2005-07)
- Orlistat is as beneficial as metformin in the treatment of polycystic ovarian syndrome. (2005-08)
- Women with polycystic ovary syndrome (PCOS) often undergo protracted treatment with metformin and are disinclined to stop: indications for a change in licensing arrangements? (2004-01)
- Laparoscopic treatment of polycystic ovaries: is its place diminishing? (2004-02)
- Should patients with polycystic ovarian syndrome be treated with metformin? A note of cautious optimism. (2002-01)
- Should patients with polycystic ovarian syndrome be treated with metformin?: an enthusiastic endorsement. (2002-03)
- Should patients with polycystic ovary syndrome be treated with metformin?: Benefits of insulin sensitizing drugs in polycystic ovary syndrome-beyond ovulation induction. (2002-04)
- Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: A pilot study (2001)
- Metformin treatment of patients with polycystic ovary syndrome undergoing in vitro fertilization improves outcomes and is associated with modulation of the insulin-like growth factors. (2001)
- Metformin increases the ovulatory rate and pregnancy rate from clomiphene citrate in patients with polycystic ovary syndrome who are resistant to clomiphene citrate alone (2001-03)
- Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebo-controlled 6-month trial, followed by open, long-term clinical evaluation.
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- Metformin-induced resumption of normal menses in 39 of 43 (91%) previously amenorrheic women with the polycystic ovary syndrome. (1999-01)
- The effects of metformin on insulin resistance and ovarian steroidogenesis in women with polycystic ovary syndrome.
style="mso-spacerun: yes">?(1999-02)
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- Effects of the insulin sensitizing drug metformin on ovarian function, follicular growth and ovulation rate in obese women with oligomenorrhoea. (1999-03)
- Insulin action in the normal and polycystic ovary.
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- Metformin therapy improves the menstrual pattern with minimal endocrine and metabolic effects in women with polycystic ovary syndrome.? (1998-01)
- Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. (1998-02)
- Menstrual cyclicity after metformin therapy in polycystic ovary syndrome. (1997-01)
- Use of metformin in the management of adolescents with polycystic ovary syndrome. (1997-02)
- Can metformin reduce insulin resistance in polycystic ovary syndrome? (1996-01)
   
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