21st Century PCOS Management at Intelligent Health Center

Insulin-sensitizing Medications Aid Polycystic Ovary Syndrome,
Even Without Insulin Resistance, Obesity
By Paula Moyer
Special to DG News

SAN FRANCISCO, CA -- June 20, 2002 -- Treatment with insulin-sensitizing medications such as metformin (Glucophage®) promotes ovulation and reduces testosterone levels in women with polycystic ovary syndrome (PCOS), even if they are relatively lean and insulin-responsive.

These findings, reported at ENDO 2002, the 84th Annual Meeting of the Endocrine Society, indicate that physicians may want to use insulin-sensitizing therapy in all women with PCOS, rather than relying on clinical assessments of insulin sensitivity, according to the investigators.

"Even if a woman with PCOS doesn't have obesity or other symptoms that would lead the physician to suspect insulin resistance, insulin-sensitizing drugs are effective," lead investigator Jean-Patrice Baillargeon, MD, said. "It was a surprising outcome to see that relatively lean women will have lower insulin levels, begin to ovulate, and have lower testosterone levels."

Dr. Baillargeon is a clinical research fellow in endocrinology at Virginia Commonwealth University in Richmond, Virginia, United States and collaborated in his research with John Nestler, professor of medicine at Virginia Commonwealth University. Dr. Baillargeon is currently on leave from his position as a professor of medicine at the University of Sherbrooke in Sherbrooke, Quebec, Canada.

In this study sponsored by the National Institutes of Health, Dr. Baillargeon and colleagues randomly assigned 100 women with PCOS who were neither overweight nor hypertensive to receive metformin, rosiglitazone (Avandia®), combination therapy, or placebo. The doses for the insulin sensitizers were 850 mg twice daily for metformin and 4 mg twice daily for rosiglitazone.

Every six months, the investigations assessed the women with respect to number of ovulations during the observation period, any changes in systolic blood pressure, and changes in free testosterone. The average body mass index (BMI) for the women was 24.5, which is considered to be within normal weight.

The metformin monotherapy group had a mean of 3.3 ovulations during this period, compared to 2.4 for the rosiglitazone monotherapy group and 3.4 for the combination group. The placebo arm had a mean of 0.4 ovulations during the study period (p<0.0001). The metformin group had a mean reduction of 4.3 mm Hg in systolic blood pressure, compared to 2.6 mm Hg for the rosiglitazone group, 4.5 mm Hg for the combination group, and 1.0 mm Hg for the placebo group (p=0.012). Free testosterone levels dropped 12.8 pmol/L in the metformin group, 12.3 pmol/L in the rosiglitazone group, 21.9 pmol/L in the combination group, and 1.2 pmol/L in the placebo group (p=0.0001).

"If using an insulin sensitizer, rosiglitazone alone will not produce sufficient change in PCOS symptoms," Dr. Baillergeon said. "Either metformin monotherapy or combination therapy should be used."

Link to PCOS Support website