Use of Metformin in the Treatment of Polycystic Ovary Syndrome

Abstract

Metformin is quite an old drug, but it is optimal for the control of glycemia in Type 2 diabetes. It was reported, 15 years ago, that insulin resistance was abnormally high in most polycystic ovary syndrome (PCOS) patients. Starting from that moment, increasing numbers of studies were performed to demonstrate the efficacy of metformin in controlling and/or modulating several aspects of PCOS, which is the most common cause of menstrual irregularity, inesthetisms and infertility. Metformin induces higher glucose uptake, thus inducing a lower synthesis/secretion of insulin. Such an effect permits the possible restoration of the normal biological functions that are severely affected by the compensatory hyperinsulinemia reactive to the increased peripheral insulin resistance. These are the basis of the many positive effects of this drug, such as the restoration of menstrual cyclicity, ovulatory cycles and fertility, because abnormal insulin levels affect the hypothalamus-pituitary-ovarian function, as well as the use of glucose in peripheral tissues. Metformin improves the impairments typically observed in hyperinsulinemic PCOS patients, reducing the possible evolution towards metabolic syndrome and Type 2 diabetes; and when pregnancy occurs, it consistently reduces the risk of gestational diabetes, eclampsia and hypertension. PCOS seems to be the perfect physiopathological condition that might have higher benefits from metformin administration, obviously after Type 2 diabetes. This review focuses on the many aspects of PCOS and on the possible issues of this disease for which metformin might be a putative optimal treatment.

Mini-Special Issue paper Management of diabetic patients with hypoglycemic agents Metformin and its clinical use: new insights for an old drug in clinical practice

“…Even in the absence of obesity or MetS, these patients may have insulin resistance and increased cardiovascular risk [86]. High insulin levels affect the hypothalamus-pituitary-ovarian function, as well as glucose utilization in peripheral tissues [87]. This syndrome was particularly considered in the evaluation of the use of metformin in adolescent patients and in pediatric clinical practice [88].…”

Commonly used fertility drugs, a diet supplement, and stress force AMPK-dependent block of stemness and development in cultured mammalian embryos

“…Aspirin (Asa) is regularly utilized for analgesia and as an antiinflammatory pharmaceutical. Met is commonly used to support women with ovulatory problems due to polycystic ovarian syndrome (PCOS) [1][2][3] and may be used by women with type 2 diabetes (T2D), and aspirin (Asa) is used by fertile and infertile women episodically for pain relief [2,[4][5][6][7][8][9][10][11][12][13] and recurrent pregnancy loss due to anti-phospholipid syndrome [14]. Met [15] and Asa [16] may have part of their therapeutic activity through the activation of AMP-activated protein kinase (AMPK).…”

Myo‐inositol modulates insulin and luteinizing hormone secretion in normal weight patients with polycystic ovary syndrome

“…For these reasons, the use of oral insulin‐sensitizing compounds such as pioglitazone, troglitazone and mainly metformin have been widely used as treatment for the hyperinsulinemic condition of PCOS patients . Though these treatments improve the ovarian function and reduce the hyperandrogenic condition improving menstrual cyclicity, they can induce various side‐effects such as gastrointestinal, reducing patients' compliance …”