Metformin and N-acetyl Cysteine in Polycystic Ovarian Syndrome–-A Comparative Study

Abstract

Objective To compare the effects of Metformin with N-acetyl cysteine in polycystic ovarian syndrome (PCOS). Methods A prospective, randomised controlled study was conducted in the Department of Obstetrics and Gynaecology in a Medical College and General Hospital. Total 115 cases of polycystic ovarian syndrome presenting with different complaints were selected for the study. Fifty nine cases were treated with Metformin (Group-M) and other 56 with N-acetyl cysteine (Group-N). Primary outcome measures are improvement in clinical features and biochemical profile, where as secondary outcome measures are improvement in hormonal profile and ultrasonographic findings. Statistical analysis was done by Z test and Chi square test. Results From each group, 50 patients were ultimately evaluated. There was significant improvement in some of the clinical features like weight gain, acne and hirsutism in group-N (P < 0.05), but there was no significant change in other features like oligomenorrhea, amenorrhoea and infertility. The biochemical markers of insulin resistance like fasting insulin, fasting glucose/insulin ratio and HOMA-IR were significantly reduced in group-N. Hormone levels like serum LH, FSH, TT and LH/FSH ratio was significantly decreased in group-N, but FT, FT/TT ratio and SHBG were similar in both the groups. Ultrasonographic findings were similar in both the groups. Conclusion N-acetyl Cysteine had better improvement in clinical, biochemical and hormonal profile than Metformin in PCOS patients. It can be used as a substitute for insulin reducing medications in treatment of PCOS patients, considering its limited adverse effects.

Comparison of metformin and N-acetylcysteine on metabolic parameters in women with polycystic ovarian syndrome

“…38 Similar mean of fasting glucose while higher values of fasting insulin and HOMA-IR was reported by a study done on 100 subjects (50 in MET and 50 in NAC group) by Gayatri K on Indian population while OGTT and QUICKI were not taken as an assessment for insulin resistance in that study. 39 In the present study, HDL<50 mg/dl was seen in 45 (91.8%) and 49 (85.9%) pts with mean of 39.04 and 40.06 mg/dl in MET and NAC group respectively while TG >150 mg/dl was seen in 6 (12.2%) and 14 (24.56%) patients in two group. It is consistent with other studies which report that dyslipidemia can be seen up to 70% of PCOS patients.…”

“…42 Different studies done by Gayatri, Salehpour and Fulghesu also reported that NAC showed no adverse effects. 6,39,40 …”

“…This is similar to the study by Gayatri K et al, who observed, significant improvement in all the parameters of insulin resistance viz fasting insulin levels, fasting glucose insulin ratio and HOMA-IR only with NAC therapy as compared to metformin therapy. 39 In a study by Salehpou et al, there was significant drop in serum fasting glucose, fasting insulin and HOMA-IR but the rise in glucose insulin ratio was not found to be significant. 40 Treating 20 PCOS women, Kilicdag noticed that despite the insignificant change in fasting plasma glucose, insulin levels dropped significantly and decline in HOMA-IR was statistically significant in NAC compared with placebo.…”

A study of N-acetyl cysteine, metformin and vitamin D3 with calcium on clinical and metabolic profile in PCOS

“…6 They concluded from the study that subjects treated with N-acetyl cysteine showed significant differences in body weight and BMI compared to the Metformin.…”

Short Review on Polycystic Ovarian Syndrome

“…Table 1 includes the researches on PCOS done in India. 17 Beena Joshi et al 18 Sanjay Chauhan et al 19 Swetha Balaji et al 20 Pratik Kumar Chatterjee et al 21 Kalavathiet al 22 Sujatha Thathapudi et al 23 Nagaraja Bhuvanashree et al 24 Sudhindra M et al 25 Harmandeep Gill et al 26 B Vijaya Gowri et al 27 Suneet Kumar et al 28 Jisha Varghese et al 29 Sudha Ambigeret al 30 Amar Nagesh Kumar et al 31 Pothiraj Pitchai et al 32 Nina Madnani et al 33 Kar Gayatri et al 34 Shaini joseph et al 35 Anuradha Kalra et al 36 Penagaluru Radha et al 37 Avin S Jamil et al 38 Maniraja Jesintha Mary et al 39 Lilhareet al 40 Vijayan CP and Sonia A. 41 Clinical characteristics of polycystic ovary syndrome in Indian women A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai …”