Endocrine Abstracts

Introduction: Polycystic ovary syndrome (PCOS) is associated with insulin resistance and hyperandrogenism. In many cases this leads to hirsutism, for which a common treatment is combined anti-androgen and estrogen therapy (Dianette; Schering Ltd). The insulin sensitising agent metformin has been reported to reduce hyperandrogenism in women with PCOS.
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.
Materials and methods: Patients were randomised to metformin (n=26) or Dianette (n=26) treatments, with assessments at time 0, 6 and 12 months. Parameters recorded included Ferriman Gallwey (FG) score, sebum excretion rate (SER), anthropometric criteria, reproductive hormones, fasting insulin and glucose. Changes during treatment were evaluated using repeated measures ANOVA.
Results: After 12 months there were 18 cases receiving metformin and 16 Dianette. The FG score improved significantly (p<0.001) with both metformin (25% reduction) and also with Dianette (5%). Hair diameter showed significant reductions in both groups during treatment (both treatments, p<0.001). SER declined with Dianette (p<0.05) but not with metformin (p=0.1).
Metformin treatment was associated with a significant increase in the fasting glucose/insulin ratio (p<0.005) while there was no change in the Dianette group. There were negligible effects of metformin upon total nor free androgen profiles, while Dianette yielded reductions in both (p<0.001). Metformin treatment was also associated with a significant reduction in BMI (p<0.001) in contrast with Dianette (p=0.5).
Conclusion: These results suggest that metformin may be more effective than Dianette in the treatment of hirsutism in women with PCOS. Dianette may be more effective for the treatment of acne, but this was not a primary outcome measure in this study.
The results imply that hirsutism in women with PCOS derives more from the abnormal insulin metabolism than the commonly associated elevated androgen profiles.