Endocrine Abstracts

Hirsutism in women with polycystic ovary syndrome (PCOS) is associated with hyperandrogenism and insulin resistance. The insulin sensitising agent metformin can reduce hyperandrogenism in women with PCOS. Conventional treatment for hirsutism in such women is combined anti-androgen and estrogen (Dianette; Schering Ltd). The aim of this study was to compare the clinical efficacy of Dianette with metformin (Glucophage; Merck, 500mgs tds) in the treatment of hirsutism in women with PCOS.

Patients were randomised to metformin treatment (n=26) or Dianette (n=26) with assessments at time 0, and 6 months. Parameters recorded included Ferriman & Gallwey (FG) score, sebum excretion rate (SER), anthropometric criteria, reproductive hormones, fasting insulin and glucose.

After 6 months there were 20 cases receiving metformin and 16 Dianette. The FG score improved significantly (p<0.001) with metformin (21.4 to 18.8 at 6 months) but changed little with Dianette (p=0.03; 23.3 to 22.9). Both treatments reduced the SER (metformin, p<0.05; Dianette, p=0.05). Metformin treatment was associated with significant reduction in BMI (p<0.001) in contrast with Dianette (p=0.5). Total testosterone was suppressed in the metformin group from 3.3 to 2.4 nmol/L (p<0.005) and in the Dianette group (3.0 to 2.0 nmol/L, p<0.05), but SHBG showed no change with metformin in contrast with the considerable increase seen in the Dianette group (p<0.001).

Metformin treatment was associated with a significant reduction in fasting insulin (p<0.05) while there was no change in the Dianette group.

These results suggest that metformin may be more effective than Dianette in the treatment of hirsutism in women with PCOS.