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Simvastatin Beats Metformin in PCOS Therapy

Both simvastatin and metformin can prompt improvements in women with polycystic ovary syndrome (PCOS) but simvastatin seems to have a stronger effect, new research suggests.

Senior author Dr. Antoni J. Duleba stated that, “Our study demonstrates that simvastatin, a medication traditionally used to lower cholesterol level, may offer long-term benefits to women suffering from PCOS by improving menstrual regularity, reducing hair growth and lowering risk factors of cardiovascular disease.”  He and his colleagues stop short of recommending statins for all women with PCOS, however, not least because the drugs aren’t safe in women who might become pregnant.

Dr. Duleba of the University of California Davis, in Sacramento and colleagues reported on a randomized trial in which 139 women received simvastatin or metformin alone or in combination for six months.

In 2009 in the same journal, the researchers published the study’s three-month results, which showed that both drugs improved hyperandrogenism and inflammation but only simvastatin improved women’s lipid profiles.

The newer data, available for 70% of the original cohort, show that women in all three groups had continuing improvements in menstrual cyclicity, hirsutism, acne, ovarian volume, body mass index and levels of C-reactive protein and soluble vascular cell adhesion molecule-1.

At six months, dehydroepiandrosterone sulfate was significantly improved only in the simvastatin group.

As before, total cholesterol and low-density lipoprotein cholesterol were significantly improved only in the simvastatin and combination groups, but with no significant changes after the first three months.

Women who received simvastatin, alone or in combination, had the greatest increases in the number of menses and a significant decline in ovarian volume. In these two groups, ovarian volume continued to fall over the second three months of the study, according to the report.

The metformin-only group had a significantly lower increase in menses compared to the other two groups. The decline in ovarian volume with metformin was only of borderline significance, with no significant change after the first three months.

Still, the authors point out that statins might not be a safe choice in fertile women. “In view of potential risks of teratogenicity, the use of statins is… contraindicated in pregnancy, and sexually active women should use reliable contraception,” they caution.

They call their results “highly encouraging” but stress that “further long-term trials evaluating different statins in various populations of women with PCOS are needed before the use of statins can be recommended in standard clinical practice.”

J Clin Endocrinol Metab 2011