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Effects of Metformin and Lifestyle Modification in Polycystic Ovarian Syndrome (PCOS)

Together with lifestyle modification, metformin lowered BMI and subcutaneous fat, and improved menstruation cycles…

Excessive weight in PCOS is often linked to insulin resistance, impaired glucose tolerance, dyslipidemia, high androgen levels, ovulation dysfunction, and subfertility. Insulin resistance is regarded as the key feature of PCOS, thus most women suffering from this syndrome are at higher risk for type 2 diabetes. Lifestyle modification has been recommended as the first line treatment for PCOS, but it is often associated with low adherence and poor sustainability. Since metformin improves insulin resistance in PCOS, it is suggested that metformin may augment lifestyle modification in the management of PCOS.

In a meta-analysis study conducted by Engar Naderpoor and colleagues, 12 randomized controlled trials were selected from multiple databases including EDLINE, EMBASE, Pubmed, Scopus, Cochrane, PsycINFO, CINAHL, Clinical Trials registry and ANZCTR. The team performed a systemic review and meta-analysis to compare the effects of lifestyle modification + metformin with lifestyle modification ± placebo, and of metformin alone with lifestyle modification ± placebo in 608 women with PCOS at any age and with any BMI.

The results of the study showed that “lifestyle + metformin were associated with lower BMI (mean difference (MD) −0.73 kg/m2, 95% confidence intervals (CI) −1.14, −0.32, P = 0.0005) and subcutaneous adipose tissue (MD −92.49 cm2, 95% CI −164.14, −20.84, P = 0.01) and increased number of menstrual cycles (MD 1.06, 95% CI 0.30, 1.82, P = 0.006) after 6 months compared with lifestyle ± placebo.” Furthermore, similar BMI can also be achieved in patients taking metformin alone for 6 months and patients with lifestyle modification only. Based on these data, Dr. Naderpoor and colleagues conclude, “metformin alone is as effective as lifestyle intervention and that the combination of metformin with lifestyle intervention has additional benefits in management of PCOS.”

According to Dr. Shorakae, coauthor of the study, “These findings provide strong evidence advocating the beneficial effects of metformin in addition to lifestyle intervention on metabolic and reproductive features of PCOS.” The author and her colleagues suggest that the use of metformin in combination with life-style change is of particular benefit when “compliance and sustainability with lifestyle modification are limited.” However, the team recommends future studies with larger sample sizes and longer duration in order to clarify the role of metformin in PCOS management.

Practice Pearls:

  • Excessive weight in PCOS is often linked to insulin resistance, impaired glucose tolerance, dyslipidemia, high androgen levels, ovulation dysfunction, and subfertility.
  • Lifestyle and metformin were associated with lower BMI and subcutaneous adipose tissue and increased number of menstrual cycles.
  • Metformin alone is as effective as lifestyle intervention and that the combination of metformin with lifestyle intervention has additional benefits in management of PCOS.

Negar Naderpoor, Soulmaz Shorakae, Barbora de Courten, Marie L. Misso, Lisa J Moran, and Helena J. Teede. Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis. Human Reproduction Update 2015. 9 June, 2015. doi: 10.1093/humupd/dmv02.