Endocrine Abstracts

Polycystic ovary syndrome (PCOS) is a common and incompletely understood endocrinopathy in women that has both metabolic and reproductive features. Pathophysiologic constructs often guide the design and interpretation of studies by researchers and the choice of treatment by clinicians. Voids in evidence lead to consensus conferences to guide the diagnosis and treatment of the syndrome, yet these remain the lowest level of evidence. This lecture will explore the role of metformin in the treatment of polycystic ovary syndrome, focusing on important clinical parameters or endpoints such as pregnancy, hirsutism, prevention of diabetes, and amelioration of cardiovascular risk. Metformin does have some limited benefit in the metabolic management of PCOS, primarily in prevention of diabetes and modest weight loss, with the majority of evidence suggesting little benefit when used as a solo agent for ovulation induction. Data are still insufficient or demonstrate no effect (or alternatively harm) in other reproductive areas such as hirsutism management and pregnancy loss. Unfavorable risk benefit ratios for other medical treatments (i.e. thiazolidinediones) or difficulties with sustainability over the long term (i.e. lifestyle modification), often lead to the choice of metformin as a default option.