Why metformin for pcos

Metformin is taken orally, and is available under the brands Fortamet, Glucophage , Glumetza , and Riomet. Gerlis advises. For weight loss and infertility, the efficacy of metformin is not as clear cut.

Killoran says that patients with PCOS who may want to try metformin therapy to manage their symptoms are typically overweight or obese and trying to conceive, or are trying to prevent metabolic syndrome, cardiovascular disease, or worsening diabetes mellitus. While metformin use is associated with weight loss, the results are inconsistent, she says. Gersh believes that the number one way to address PCOS is through lifestyle changes and new habits, such as eating a plant-based diet, reducing stress, focusing on sleep, and incorporating physical exercise.

The most commonly recommended natural treatments for PCOS are finding ways to be more active and eating more whole foods. For her patients, Dr. Gersh recommends a variety of vitamin supplements, in conjunction with dietary changes and exercise to treat symptoms of PCOS. Meanwhile, Dr. Killoran says that PCOS impacts each person differently. If you are considering metformin, schedule a follow-up with your doctor to see what is right for you.

Skip to main content Search for a topic or drug. By Brianna Bell Sep. It helps improve the ability of cells in the body to respond to the normal actions of insulin. Many women with PCOS have what is known as 'insulin resistance' see ' what is polycystic ovary disease? The effects of metformin on the body's response to insulin suggest it might be helpful in managing the symptoms of PCOS, for example in women who don't want to take other treatments or for whom these aren't suitable.

Metformin has a license in the UK for treating type 2 diabetes, particularly for people who are overweight. After reading the titles and abstracts, an additional articles were excluded, and articles were retained. Among them, articles did not meet the inclusion criteria, 15 studies were improperly compared, and in 18 studies, we could not extract the data.

Finally, twelve RCTs with a total of participants were included. The principal study characteristics are summarized in Table 1. Twelve studies were published between and A total of participants were included. The number of participants in the individual studies ranged from 9 to All of the included trials were single-center studies. The included studies came from different countries: United States [ 27 ], United Kingdom [ 30 , 31 ], Iran [ 23 , 28 , 29 ], Brazil [ 22 , 24 ], Italy [ 25 , 27 ], India [ 32 ], and Turkey [ 33 ].

The duration of the intervention varied from 6 to 48 weeks. Figure 2 provides an overview of the risk of bias for the included studies based on the tools provided by the Cochrane Manual. All included studies used a double-blind approach and reported dropouts.

Most trials reported allocation concealment and random allocation but did not mention the specific method used. Five studies [ 25 — 27 , 30 , 31 ] reported automatic generation of random sequences by a computer, while two studies [ 23 , 28 ] reported that they divided participants into an experimental group and a control group by using random number tables.

Selective reporting was unbiased but without any description to evaluate the existence of other biases. All the included trials reported whether adverse events occurred. Figure 3 a shows the forest plots of the BMI analysis. The number of RCTs included was twelve. Nine included trials including participants [ 26 , 31 — 33 ] reported data on changes in testosterone following metformin use.

The publication bias of the twelve RCTs was evaluated with a funnel plot. Figure 5 shows that the publication bias across the studies was small. Polycystic ovary syndrome polycystic ovary syndrome, PCOS is a gynaecological endocrine disorder commonly seen in women of reproductive age and has highly heterogeneous clinical manifestations [ 34 ].

Obesity as a risk factor often causes female diseases such as breast cancer [ 36 ]. Studies have found that, with increases in weight, abnormal genes such as the Wnt signalling pathway, oxidative stress, and inflammation in adipose tissue of PCOS patients are abnormal [ 37 ], suggesting that obesity participates in the pathogenesis of PCOS [ 38 ], triggers metabolic and reproductive disorders, and may also cause glycolipid metabolism, hyperandrogenaemia, menstrual disorders, infertility, and comorbidities related to polycystic ovary syndrome [ 39 ].

Furthermore, we also noticed that many features and complications of polycystic ovary syndrome PCOS can trigger oxidative stress and increase insulin resistance index [ 40 , 41 ]. Current evidence-based guidelines recommend that overweight women with PCOS use metformin to control their weight and endocrine and metabolic disorders [ 43 ].

As the most widely used insulin sensitizer for PCOS, metformin can reduce liver glucose production, inhibit gluconeogenesis and adipogenesis, and improve peripheral tissue insulin sensitivity [ 44 ]. In addition, a large number of studies have shown that metformin can not only reduce weight and metabolic disorders but also correct menstrual patterns, restore ovulation, and even allow conception [ 45 , 46 ].

Furthermore, in previous systematic reviews, the specific therapeutic effect of metformin on metabolic indicators in overweight women with PCOS has not been evaluated. Our current results suggest that metformin may be the most effective intervention for PCOS in overweight women [ 47 ].

The results show that the improvement of body mass index, waist circumference, and LDL cholesterol may be the direct regulation effect of metformin on the production of ovarian steroids [ 11 , 48 ]. It can be considered as abnormal gonadotrophic secretion in women with overweight PCOS, which makes FSH in an abnormal secretion stage [ 49 ]. The antireproductive effect of metformin helps correct this phenomenon [ 50 ]. The production of polycystic ovary syndrome is directly related to the abnormality of insulin.

Insulin resistance will cause hyperinsulinemia, which directly affects the role of ovarian receptors, inhibits insulin-binding protein and sex hormone-binding protein, while freeing testosterone and increasing ovarian androgens. Therefore, metformin is used to regulate insulin secretion and achieve the purpose of effectively improving polycystic ovary syndrome.

This finding is consistent with international guidelines for the management of overweight and diseased adults and overweight people. Most approved weight management drugs are contraindicated in women of reproductive age, but metformin has fewer side effects, is safer, and is recommended for use in PCOS treatment [ 51 ].

Clinical studies of overweight women with PCOS have found that endocrine disorders can lead to infertility [ 52 ]. This study found that metformin has a certain regulatory effect on PCOS sex hormones in overweight women, can promote luteinizing hormone secretion, achieve ovulation, and improve the menstrual cycle of patients. In addition, it has the function of regulating follicle-stimulating hormone secretion.

Some studies have suggested that the abnormal state of ovarian ultrasound detection in patients with polycystic ovary syndrome is closely related to testosterone levels [ 53 ]. Studies have also confirmed that reduced testosterone levels can effectively improve the hyperandrogenaemia of PCOS in overweight women and improve clinical symptoms such as excess hair, black acanthosis, and acne [ 54 ].

This study has several limitations. First, in some cases, we had to calculate and transform data rather than data being provided directly. Second, the study distribution between the twelve RCTs was included, which may affect the meta-analysis results. The results of the included studies showed significant differences, which may be due to the different metformin doses, durations, center settings, and selected populations of different treatment programs. We performed a sensitivity analysis of the included RCTs and found that two studies may be a source of most of the heterogeneity.

In both studies, different laboratory tests were used, which may have an impact on the comprehensive measurement results. Finally, this review only included randomized controlled trials. In the future, there is a need for a greater diversity of research, such as cooperation between multiple centres, more rigorous clinical reports, and prospective studies. Although this study shows that metformin can effectively regulate the levels of BMI and physiological function indicators in overweight PCOS women, more clinical studies are needed in the future to prove that effective prevention can reduce the occurrence of complications such as hypertension and stroke [ 55 , 56 ].

This result should be interpreted with caution due to the insufficient quality of current evidence research methods and the observed clinical heterogeneity. In future studies, further attention should be paid to the effects of metformin dosage and intervention time in overweight women with PCOS. In conclusion, this study found that metformin has a certain regulatory effect on the relevant physiological indicators of overweight women with PCOS.

We have to admit that this study may have some serious limitations. Different treatment options, doses, duration, and enrolment of different populations may have led to obvious heterogeneity, and we need to interpret the results carefully.

More RCTs with a rigorous research design are needed to determine the efficacy of metformin in treating PCOS patients, to evaluate the risk factors in overweight women, and to apply metformin in interventions for nonoverweight PCOS patients to prevent or treat the occurrence of PCOS and its complications. The authors gratefully acknowledge the support from the National Key Research and Development Program of China approval no.

Supplementary Materials. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview. Special Issues.

Academic Editor: Davide Francomano. Received 15 Jun Revised 02 Aug Accepted 05 Sep Published 16 Sep Abstract Objective. Introduction Polycystic ovary syndrome PCOS is a common gynaecological endocrine disease in women of childbearing age [ 1 ]. Methods 2. Data Extraction Two review authors independently screened the literature using the predetermined inclusion criteria and extracted data from the trials. Statistical Analysis 2. Results 3. Study Selection A total of study reports were screened, of which were excluded because they were duplicate publications.

Figure 1. Table 1. Systematic review of randomized controlled trials evaluating the effects of metformin in overweight women with polycystic ovary syndrome. Figure 2. Figure 3. Effect of metformin on a body mass index; b waist circumference; c fasting insulin; d testosterone; e follicle-stimulating hormone; f luteinizing hormone; and g low-density lipoprotein.

Figure 4. Effect of metformin on a homeostasis model assessment of insulin resistance; b sex hormone-binding globulin; c high-density lipoprotein; d total plasma cholesterol; e triglycerides; f fasting blood glucose; and g androstenedione. Figure 5. References R. Legro, S. Arslanian, D. Ehrmann et al. Norman, D. Dewailly, R. Legro, and T. Mu, Y. Zhao, R. Li, Y.

Lai, and J. Arya, K. Hansen, and R. Shi, D. Feng, M. Sagnelli et al. View at: Google Scholar E.