Insulin-sensitizing agents in polycystic ovary syndrome

Abstract

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.

Polycystic Ovary Syndrome: Features, Diagnostic Criteria and Treatments

“…Insulin sensitizing agents such as metformin, ioglitazone and troglitazone, have been proposed as treatment for PCOS-associated hyperinsulinemia [129,130]. Metformin may antagonize some hyperandrogenic signs, by reducing total and free testosterone concentrations [131,132].…”

Obesity and Diabetes

“…A change in endometrial gene and protein expression after in vitro stimulation with metformin was demonstrated, including a diminished decidualisation process and changes in genes relevant to implantation (Germeyer et al 2011). Metformin concomitantly restored menstrual cycles and increased conception rates in women with PCOS (Pasquali and Gambineri 2006). Notably, PCOS patients with a positive response to metformin treatment had significantly lower pretreatment sex-hormone binding globulin (SHBG) levels (Wassell et al 2011).…”

Reflections on inositol(s) for PCOS therapy: steps toward success

“…The demonstrated efficacy of insulin-sensitizing drugs, such as metformin, troglitazone and pioglitazone, in improving ovulatory function and reducing androgen excess in PCOS provided additional proof to support insulin resistance's pathogenic role in PCOS. However, side effects such as nausea and diarrhea (in the case of metformin) and increased body weight (in the case of pioglitazone) may reduce patients' compliance and limit the use of these drugs [4][5][6].…”