Clinical, endocrine and metabolic effects of metformin added to ethinyl estradiol-cyproterone acetate in non-obese women with polycystic ovarian syndrome: a randomized controlled study

Elter, Koray; İmir, Gonca; Durmuşoğlu, Fatih

doi:10.1093/humrep/17.7.1729

Cited by 138 publications

(105 citation statements)

References 48 publications

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“…Some studies compared OCs with the combined therapy of OCs and metformin. Elter et al (67) found that the combined therapy led to a greater decrease in androstenedione and to a more pronounced increase in SHBG, without any significant difference on changes in body mass index (BMI), waist:hip ratio and glucose:insulin ratio. In another study performed in a larger group of PCOS women, Vrbikova and Cibula (68) confirmed these findings.…”

Section: Metformin and Oral Contraceptivesmentioning

confidence: 99%

Insulin-sensitizing agents in polycystic ovary syndrome

Pasquali

Gambineri

2006

eur j endocrinol

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Insulin-sensitizing agents have been recently proposed as the therapy of choice for polycystic ovary syndrome (PCOS), since insulin resistance and associated hyperinsulinemia are recognized as important pathogenetic factors of the syndrome. Moreover, since almost all obese PCOS women and more than half of those of normal weight are insulin resistant, and therefore present some degree of hyperinsulinemia, the use of insulin sensitizers should be suggested in most patients with PCOS. Insulin sensitizer treatment has been associated with a reduction in serum androgen levels and gonadotropins, and with an improvement in serum lipids and in prothrombotic factor plasminogenactivator inhibitor type 1, whatever the insulin sensitizer used. This therapy has also been associated with a decrease in hirsutism and acne, and with a regulation of menses and an improvement of ovulation and fertility. Notable improvements in all these parameters have also been described after a change in lifestyle approach, particularly in the presence of obesity. Lifestyle interventions should therefore be combined with insulin sensitizers in PCOS when obesity is present.

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Section: Metformin and Oral Contraceptivesmentioning

confidence: 99%

Insulin-sensitizing agents in polycystic ovary syndrome

Pasquali

Gambineri

2006

eur j endocrinol

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“…On the other hand, the slight worsening of glucose tolerance with compensatory hyperinsulinemia and the increase in serum FFA levels induced by the EE -CA pill (3, 10, 11) could explain some of the negative effects of this treatment on the lipid profile, such as the increase in serum triglyceride levels. Recently, the addition of metformin to EE -CA OC pill treatment has been shown to improve the lipid profile and insulin sensitivity in non-obese women with PCOS, compared with EE -CA treatment alone, suggesting that at least some women with PCOS could benefit from the combination of OC pill and metformin (43).…”

Section: Metforminmentioning

confidence: 99%

Effects of metformin and ethinyl estradiol–cyproterone acetate on lipid levels in obese and non-obese women with polycystic ovary syndrome

et al. 2005

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Objective: Women with polycystic ovary syndrome (PCOS) exhibit risk factors for cardiovascular diseases such as abdominal obesity, insulin resistance and dyslipidemia. Insulin sensitizers, especially metformin, have been shown to improve these metabolic disturbances, but there are only a few studies on their effects on serum lipids in polycystic ovary syndrome. Methods: Thirty-five women with PCOS (18 obese and 17 non-obese) were randomized to 6-month treatments with metformin or ethinyl estradiol -cyproterone acetate oral contraceptive pills. Results: In the whole-study population (non-obese and obese women) serum levels of high-density lipoprotein cholesterol increased from 1.4^0.2 to 1.6^0.1 mmol/l (means^S.E. throughout) at 3 and 6 months (P , 0.001), the total cholesterol:high-density lipoprotein cholesterol ratio decreased significantly from 3.8^0.3 to 3.3^0.2 at 6 months (P , 0.001) and a similar trend was observed in serum triglyceride levels during metformin treatment. In the oral contraceptive group, serum levels of total cholesterol increased from 4.9^0.3 to 5.4^0.3 mmol/l (P , 0.05), high-density lipoprotein cholesterol increased from 1.2^0.1 to 1.5^0.1 mmol/l (P , 0.001), the total cholesterol:high-density lipoprotein cholesterol ratio decreased from 4.6^0.4 to 3.7^0.2 (P , 0.001) and triglycerides increased from 1.3^0.1 to 1.9^0.2 mmol/l at 6 months of treatment (P , 0.001). Serum low-density lipoprotein cholesterol levels remained unchanged during both treatments. Milder but similar changes in the subgroups of obese and non-obese women were observed during both treatments. Moreover, in the whole-study population both systolic (P ¼ 0.02) and diastolic (P ¼ 0.05) blood pressures decreased over the 6 months of metformin treatment. Conclusion: In women with PCOS, metformin treatment had beneficial effects on lipid profile and blood pressure, and therefore it could be useful in the prevention of cardiovascular complications in these women. 152 269-275 European Journal of Endocrinology

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“…The prevalence has been stated to be as high as 43% in these patients, which is twofold more than the age-adjusted prevalence rate of 24% nationally, displayed in the NHANES III survey data analysis (Morin-Papunen, Vauhkonen et al 2000). Dokras et al revealed the age-and BMI-adjusted prevalence of the metabolic syndrome to be 47% in women with PCOS compare to 4.3% in controls, which renders to an eleven-fold increased risk (Elter, Imir et al 2002).…”

Section: Metabolic Syndromementioning

confidence: 91%

“…Unexpectedly, Dokras et al also displayed a 23% prevalence of the metabolic syndrome in those women with PCOS under 30 years of age, compared to 0% for their counterparts without PCOS and 6.7% prevalence among the same demografic values in women in the NHANES study (Elter, Imir et al 2002;Shroff, Kerchner et al 2007). Consequently, these researchers suggested that all women with PCOS be screened for the metabolic syndrome.…”

Section: Metabolic Syndromementioning

confidence: 94%