Endocrine Abstracts

In 2002, we introduced metformin as an alternative treatment option of the anti-androgenic contraceptive pill in polycystic ovary syndrome (PCOS). The analysis of our observations is presented here.

170 women (age 14–45 y) were diagnosed with PCOS according to the Rotterdam criteria. 88% had acne, 68% hirsutism, 46% irregular menstrual cycles, 39% BMI over 25 kg/m², 13.5% had apple-type obesity and 4.7% acanthosis nigricans. 104/170 patients were offered metformin 500 mg tablets three times daily who did not want to take the anti-androgenic contraceptive pill. Body mass index, waist-to-hip ratio, Global Acne Score, Ferriman-Gallwey score and the regularity of menstrual periods were registered every three months.

12 patients had transient vertigo, diarrhoea or abdominal discomfort at the beginning of the treatment; four patients discontinued metformin because of them. A 3 to 42 month follow-up period of 47 patients on metformin could be evaluated. Irregular menstrual cycles of 13/24 patients became regular within three months of treatment. Six women became pregnant during the 1st–17th months on metformin, two continued metformin throughout and delivered healthy babies. One of them who suffered from pre-eclampsia during all of her previous pregnancies remained symptom-free throughout this pregnancy. The Global Acne Score diminished from 20.0±12.9 to 6.3±7.1, and the Ferriman-Gallwey score from 16.9±8.3 to 10.5±6.8 in 15 patients during the first 12 months of treatment.

The direct comparison of these results cannot be made to those who opted for contraception because of the different indication of treatment, furthermore the metformin group contained more severe cases in many respects (obesity, acne and hirsutism). Despite this, metformin treatment resulted in favourable improvement of the symptoms in patients with PCOS and seems to be suitable for long-term use.