Polycystic ovary syndrome (PCOS) is a common hormonal disorder in women that is characterized by excessive androgen and menstrual dysfunction. Originally believed to be a cosmetic and fertility problem, PCOS can increase risk of cardiovascular disease and diabetes mellitus. The cause of PCOS is not fully understood, but insulin resistance and hyper-insulinemia can increase androgen production in the ovaries and adrenal glands. Studies have found that weight loss and the use of insulin-sensitizing agents have improved clinical status and hyperinsulinemia, and reduced excessive androgens in women with the syndrome. However, these studies do not address PCOS in adolescents. Bridger and colleagues evaluated insulin-sensitizer (metformin [Glucophage]) use with healthy lifestyle counseling in adolescents with the disorder.
The study included 22 adolescent women diagnosed with PCOS. Participants had to be at least 12 years of age, have initiated menarche at least two years before the enrollment, and have no other cause for hyperinsulinemia or hyperandrogenism. Baseline data were collected before the study for height, weight, blood pressure, and hirsutism score. A baseline laboratory assessment also was performed and included a 75-g glucose tolerance test, with blood sugar and insulin measurements at 0, 30, 60, 90, and 120 minutes. Lipid panels and testosterone and progesterone levels were included in the first blood draw. Every adolescent participated in counseling, which included information about healthy eating and physical activity. Participants received metformin or placebo for 12 weeks, at which time the laboratory assessment was repeated.
The metformin group had a significant reduction in mean serum testosterone levels compared with the placebo group and was 2.5 times more likely to have menses. Insulin sensitivity showed improvement in the metformin group, but it did not reach statistical significance. High-density lipoprotein (HDL) cholesterol levels improved significantly in the metformin group, but there was no change in triglyceride, low-density lipoprotein, or total cholesterol levels. There also was no change in body mass index or hirsutism score at the end of the study.
The authors conclude that metformin lowers testosterone levels and improves menstrual regularity in adolescent women with PCOS. They also note an improvement in HDL cholesterol but none in other lipid parameters. There is a trend toward improvement in insulin sensitivity in the metformin group, but long-term follow-up studies need to be performed to determine if it is significant.