Polycystic Ovarian Syndrome: Metformin or Thiazolidinediones for Cardiovascular Risk Reduction?

Abstract

Objective. The purpose of this article is to explore the relationships among polycystic ovarian syndrome (PCOS), diabetes, and cardiovascular (CV) risk and review the use of metformin and thiazolidinediones (TZDs) in reducing CV risk in women with PCOS. Methods. The authors conducted a search for and reviewed reports of clinical trials, meta-analyses, and controlled trials published from January 1998 to December 2012 included in the PubMed, Cochrane Collaborative, and Health and Psychosocial Instruments databases. Search terms included PCOS, polycystic ovary/ovarian syndrome, diabetes mellitus, hyperglycemia, cardiovascular, metformin, TZDs, thiazolidinediones, rosiglitazone, and pioglitazone. Results. The articles provided evidence that PCOS is associated with both metabolic syndrome and diabetes in women. Metformin is an effective treatment for diabetes with favorable effects on lipid abnormalities to reduce CV risk. TZDs demonstrate some benefit on clinical markers associated with PCOS. However, there is no evidence that TZDs provide a greater benefit than metformin in reducing CV risk in women with PCOS and diabetes. Additionally, there is concern that TZDs may increase patients' risk of adverse events. Conclusions. Based on evidence linking PCOS to diabetes and increased CV risks, clinicians should systematically screen women with diabetes for PCOS and direct appropriate treatment at minimizing related risks. Treatment with metformin appears to be more beneficial than TZDs and has been shown to lower triglycerides, increase HDL cholesterol, and favorably influence serum insulin levels.

Suppression of neurotransmission on gonadotropin-releasing hormone neurons in letrozole-induced polycystic ovary syndrome: A mouse model

“…Next, the effect of thiazolidinedione on THDOC-induced response in GnRH neurons of the control and letrozole-fed mice was assessed ( Figure 3B ). Thiazolidinedione is a medicine used for treating type 2 diabetes and PCOS ( 35 ). Pretreatment of the slice with thiazolidinedione for 10 to 15 minutes resulted in slight decrease of THDOC-mediated response in GnRH neurons from the control group (THDOC: -25.2 ± 1.90 pA, n = 7, THDOC + Thiazolidinedione: -19.9 ± 3.95 pA, n = 5; p > 0.05, unpaired t-test, Figure 3C ).…”

“…Next, kisspeptin evoked excitation on GnRH neurons from both the control and letrozole-fed mice was recorded in the presence of metformin and thiazolidinedione, both drugs are used in treatment of PCOS and type 2 diabetes mellitus (35). Metformin and thiazolidinedione were bath applied to the GnRH neurons for at least 10 to 15 min before the kisspeptin p e r f u s i o n .…”

Efficacy of metformin use to induce ovulation in women with polycystic ovarian syndrome

“…12 According to the Janci et al, 13 metformin has shown many beneficial effects in women with PCOS, including improvement in regulating the menstrual cycle, rate of ovulation, fertility, hirsuitism, and weight. 13 The authors also go on to suggest that metformin may also decrease cardiovascular risk associated with diabetes and could also have this benefit in women with PCOS. Metformin treatment also enhances both adiponectin activity and insulin sensitivity, resulting in a less hyper androgenic state in PCOS patients.…”