Metformin polycystic
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Metformin in the Management of Polycystic Ovary Syndrome (PCOS)
Introduction to PCOS and Metformin
Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder characterized by irregular ovulation, elevated levels of male hormones, and insulin resistance. Metformin, an insulin-sensitizing drug, has been widely studied for its potential benefits in managing PCOS symptoms, particularly in improving reproductive and metabolic outcomes.
Metformin and Lifestyle Modification in PCOS
Combining metformin with lifestyle modifications has shown promising results in managing PCOS. A systematic review and meta-analysis revealed that the combination of metformin and lifestyle changes significantly reduced BMI and subcutaneous adipose tissue, and increased the number of menstrual cycles compared to lifestyle modifications alone or with a placebo. However, no significant differences were observed in other metabolic, reproductive, and psychological outcomes.
Metformin's Impact on Ovulation and Pregnancy Rates
Metformin has been found to be effective in inducing ovulation in women with PCOS. Studies have shown that metformin alone or in combination with clomiphene citrate significantly improves ovulation and pregnancy rates compared to placebo or clomiphene alone . However, while metformin improves clinical pregnancy rates, there is no conclusive evidence that it enhances live birth rates .
Metformin and Metabolic Parameters
Metformin has demonstrated benefits in reducing fasting insulin levels, blood pressure, and low-density lipoprotein (LDL) cholesterol in women with PCOS . Despite these metabolic improvements, metformin does not appear to significantly affect body mass index (BMI) or waist-to-hip ratio .
Gastrointestinal Side Effects
One of the notable side effects of metformin is gastrointestinal disturbances, including nausea and vomiting. These side effects are more common with metformin compared to placebo or no treatment . Despite these side effects, no serious adverse effects have been reported .
Metformin During Pregnancy
The use of metformin during pregnancy in women with PCOS has been investigated for its potential to reduce pregnancy complications. A randomized controlled trial (PregMet2) found that metformin might reduce the risk of late miscarriage and preterm birth, although it does not prevent gestational diabetes. A pooled analysis of multiple trials supported these findings, showing a significant reduction in late miscarriage and preterm delivery with metformin use.
Long-term Effects and Predictors of Response
Long-term studies have shown that metformin can lead to sustained improvements in menstrual abnormalities and ovulation in women with PCOS. Higher baseline plasma insulin levels, lower serum androstenedione, and less severe menstrual abnormalities are predictors of a positive clinical response to metformin.
Conclusion
Metformin is a valuable treatment option for managing PCOS, particularly in improving ovulation and metabolic parameters. While it shows promise in combination with lifestyle modifications and other ovulation induction agents, its impact on live birth rates remains inconclusive. Gastrointestinal side effects are common but manageable. Further research is needed to clarify the long-term benefits and safety of metformin in PCOS management, especially during pregnancy.
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