Endocrine Abstracts

Insulin resistance has been suggested to have a pathogenic role in polycystic ovary syndrome (PCOS). The use of insulin sensitising drugs might therefore have a therapeutic role in its management.

We studied 20 patients (mean age 32.6 years) with PCOS (diagnosed by the Rotterdam Consensus Workshop group criteria, 2003) before and after treatment with metformin (1.5–3 grams daily) for 6 to 12 months.

Clinical features studied were menstrual pattern, body mass index (BMI) and hirsutism by means of Ferriman & Gallwey (F&G) scores.

Biochemical parameters included fasting glucose, insulin, lipid profile, total testosterone, FSH, LH, SHBG, DHEAS, androstenedione, basal and ACTH stimulated 17-hydroxyprogesterone levels. Free and bioavailable testosterone levels were calculated using a software programme available from www.issam.ch/freetesto.htm.

Insulin resistance and sensitivity% were determined using the homeostatic model assessment (HOMA 2) software programme available from www.dtu.ox.ac.uk.

Menstrual cycles became regular in 15 patients (75%). F&G significantly improved (P=0.009). There was no significant change in BMI. Significant reductions were recorded in fasting glucose, insulin, total testosterone, LH, free testosterone, bioavailable testosterone and insulin resistance (all P<0.05). Insulin sensitivity % also significantly improved (P<0.05). There were no significant changes in lipid profiles, FSH, SHBG, androstenedione, DHEAS and 17 hydroxyprogesterone levels. There was a significant positive correlation between the fall in insulin levels and basal BMI, glucose and insulin levels (r=0.79, 0.77, and 0.91 respectively)

This study suggests a useful role for metformin in the management of PCOS. Improvement in clinical features and hyperandrogenism paralleled improvements in insulin sensitivity.