How does metformin help pcos
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These studies suggest metformin helps PCOS by improving body weight, metabolism, ovarian function, immune response, and pregnancy outcomes, often through pathways involving SIRT3/AMPK/mTOR, SIRT1, and PI3K/AKT/mTOR.
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How Metformin Helps in Managing Polycystic Ovary Syndrome (PCOS)
Introduction to PCOS and Metformin
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age, characterized by symptoms such as anovulation, hyperandrogenism, and insulin resistance. Metformin, a medication primarily used to treat type 2 diabetes, has been widely adopted for managing PCOS due to its multifaceted benefits.
Metformin and Insulin Resistance in PCOS
One of the primary mechanisms by which metformin aids in PCOS management is through the improvement of insulin sensitivity. PCOS is often associated with insulin resistance, which exacerbates hyperinsulinaemia and contributes to the disorder's metabolic and reproductive symptoms. Metformin helps reduce insulin levels, thereby improving ovulation and menstrual regularity .
Metformin's Role in Weight Management
Weight management is crucial for women with PCOS, as obesity can worsen insulin resistance and other symptoms. Studies have shown that metformin, especially when combined with lifestyle modifications, can lead to significant reductions in body mass index (BMI) and subcutaneous adipose tissue. This combination also enhances menstrual cyclicity and ovulation rates .
Metformin and Ovarian Function
Metformin has been found to improve ovarian function by reducing polycystic lesions and restoring normal ovarian morphology. It achieves this by modulating pathways such as the SIRT3/AMPK/mTOR pathway, which are involved in cellular metabolism and stress responses . Additionally, metformin decreases excessive autophagy in ovarian granulosa cells via the PI3K/AKT/mTOR pathway, further contributing to the amelioration of PCOS symptoms.
Immunomodulatory Effects of Metformin
In pregnant women with PCOS, metformin has been observed to have immunomodulatory effects. It increases the levels of multifunctional cytokines, which may help reduce the risk of pregnancy complications such as late miscarriage and preterm birth. This effect is more pronounced in women with normal or overweight BMI compared to those who are obese.
Metformin in Combination Therapies
Combining metformin with other treatments can enhance its efficacy. For instance, the combination of Diane-35 (an oral contraceptive) and metformin has been shown to improve ovulation and glucose metabolism in PCOS models. This combination therapy regulates the glycolysis pathway, which is crucial for energy metabolism in ovarian tissues. Additionally, combining metformin with clomifene, an ovulation induction agent, significantly increases ovulation and pregnancy rates compared to clomifene alone.
Metformin and Assisted Reproductive Technologies
For women with PCOS undergoing in vitro fertilization (IVF), metformin has been shown to improve pregnancy outcomes and reduce the incidence of ovarian hyperstimulation syndrome (OHSS). Although it does not significantly affect the fertilization rate or the number of oocytes retrieved, its benefits in reducing OHSS and improving clinical pregnancy rates make it a valuable adjunct in IVF treatments.
Conclusion
Metformin is a versatile and effective treatment for managing PCOS. It improves insulin sensitivity, aids in weight management, enhances ovarian function, and has beneficial immunomodulatory effects. When used alone or in combination with other therapies, metformin significantly improves reproductive and metabolic outcomes in women with PCOS. Future research should continue to explore the long-term safety and efficacy of metformin in diverse populations of women with PCOS.
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