Nonobese women with polycystic ovary syndrome respond better than obese women to treatment with metformin

Maciel, Gustavo Arantes Rosa; Júnior, José Maria Soares; Motta, E.L.A.; Haidar, Mauro Abi; Lima, Geraldo Rodrigues de; Baracat, Edmund Chada

doi:10.1016/j.fertnstert.2003.08.012

Cited by 142 publications

(68 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This drug also reduces appetite in many PCOS women and is thus often [133], but not always [134], associated with more weight loss. Metformin has been shown to be effective in all women with PCOS, even those without insulin resistance and hyperinsulinemia [47, [135][136][137], but tends to be more effective in lean as compared to obese PCOS women [138]. The effects of metformin in PCOS are probably mainly mediated through a reduction in insulin levels, which is observed both in insulin-sensitive and insulin-resistant PCOS women because of the reduction in hepatic glucose production.…”

Section: Insulin-sensitizing Drugsmentioning

confidence: 99%

Insulin and hyperandrogenism in women with polycystic ovary syndrome

Baptiste

Battista

Trottier

et al. 2010

The Journal of Steroid Biochemistry and Molecular Biology

266

199

View full text Add to dashboard Cite

Polycystic ovary syndrome (PCOS) is a very common endocrine disorder characterized by chronic anovulation, clinical and/or biochemical hyperandrogenism, and/or polycystic ovaries. But most experts consider that hyperandrogenism is the main characteristic of PCOS. Several theories propose different mechanisms to explain PCOS manifestations: (1) a primary enzymatic default in the ovarian and/or adrenal steroidogenesis; (2) an impairment in gonadotropin releasing hormone (GnRH) secretion that promotes luteal hormone (LH) secretion; or (3) alterations in insulin actions that lead to insulin resistance with compensatory hyperinsulinemia. However, in the past 20 years there has been growing evidence supporting that defects in insulin actions or in the insulin signalling pathways are central in the pathogenesis of the syndrome. Indeed, most women with PCOS are metabolically insulin resistant, in part due to genetic predisposition and in part secondary to obesity. But some women with typical PCOS do not display insulin resistance, which supports the hypothesis of a genetic predisposition specific to PCOS that would be revealed by the development of insulin resistance and compensatory hyperinsulinemia in most, but not all, women with PCOS. However, these hypotheses are not yet appropriately confirmed, and more research is still needed to unravel the true pathogenesis underlying this syndrome. The present review thus aims at discussing new concepts and findings regarding insulin actions in PCOS women and how it is related to hyperandrogenemia.

show abstract

Section: Insulin-sensitizing Drugsmentioning

confidence: 99%

Insulin and hyperandrogenism in women with polycystic ovary syndrome

Baptiste

Battista

Trottier

et al. 2010

The Journal of Steroid Biochemistry and Molecular Biology

266

199

View full text Add to dashboard Cite

show abstract

“…This finding is in accordance with several smaller previous studies, which however did not include healthy controls (Table 1). For example, in a Brazilian study with 29 PCOS patients hyperandrogenemia was reduced by treatment with 500 mg three times daily (TID) metformin (29). In addition, lean PCOS patients benefitted from metformin through a reduction of AUCI and fasting insulin.…”

Section: Effects Of Metformin Treatmentmentioning

confidence: 99%

“…In addition, lean PCOS patients benefitted from metformin through a reduction of AUCI and fasting insulin. Maciel et al (29) concluded that lean PCOS patients respond even better to treatment with metformin than obese patients. Kumari et al (30) demonstrated in a study including 17 lean and 17 obese PCOS patients treated with 1500 mg metformin daily that ovulation and pregnancy rates were higher in the lean PCOS group.…”

Section: Effects Of Metformin Treatmentmentioning

confidence: 99%

Metformin improves polycystic ovary syndrome symptoms irrespective of pre-treatment insulin resistance

Tan

Hahn

Benson

et al. 2007

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: Insulin resistance (IR) and obesity are common features of the polycystic ovary syndrome (PCOS). Insulin-sensitizing agents have been shown to improve both reproductive and metabolic aspects of PCOS, but it remains unclear whether it is also beneficial in lean patients without pretreatment IR. The aim of this study was to determine the influence of metformin on the clinical and biochemical parameters of PCOS irrespective of the presence of basal obesity and IR. Design: The effect of 6 months of metformin treatment was prospectively assessed in 188 PCOS patients, divided into three groups according to body mass index (BMI; lean: BMI!25 kg/m 2 , overweight: BMI 25-29 kg/m 2 , and obese: BMIR30 kg/m 2 ). Outcome parameters, which were also assessed in 102 healthy controls, included body weight, homeostasis model assessment for IR (HOMA-IR), fasting glucose and insulin levels, area under the curve of insulin response (AUCI), hyperandrogenism, and menstrual irregularities. Results: In comparison with the respective BMI-appropriate control groups, only obese but not lean and overweight PCOS patients showed differences in fasting insulin and HOMA-IR. Metformin therapy significantly improved all outcome parameters except fasting glucose levels. Subgroup analyses revealed that in the group of lean PCOS patients without pre-treatment IR, metformin significantly improved HOMA-IR (1.7G1.0 vs 1.1G0.7 mmol/l!mmol/l 2 ) and fasting insulin levels (7.7G4.2 vs 5.4G3.9 mU/l), in addition to testosterone levels (2.6G0.9 vs 1.8G0.7 nmol/l), anovulation rate (2.3 vs 59.5%), and acne (31.8 vs 11.6%; all P!0.017). In the overweight and obese PCOS groups, metformin also showed the expected beneficial effects. Conclusion: Metformin improves parameters of IR, hyperandrogenemia, anovulation, and acne in PCOS irrespective of pre-treatment IR or obesity.European Journal of Endocrinology 157 669-676

show abstract

“…For example, multiple pregnancies have not occurred with metformin therapy in Italy,10 whereas they have occurred in 6.0% of patients in the USA in a randomized, controlled trial11 during clomiphene therapy. The metformin treatment was effective in inducing ovulation or recovering the normal menstrual cycle in the lean or normal BMI patients with PCOS 12, 13, 14, 15, 16, 17, 18, 19, 20. Furthermore, some reports have indicated that non‐obese (BMI<30 kg/m 2 ) patients with PCOS were more likely to respond to metformin than obese (BMI≥30 kg/m 2 ) patients with PCOS due to decreased sex steroids and increased ovulation rates 12, 14.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of various metformin treatments for women with polycystic ovary syndrome

Matsuzaki

Tungalagsuvd

Iwasa

et al. 2017

Reprod Medicine & Biology

View full text Add to dashboard Cite

AimPolycystic ovary syndrome (PCOS) is an ovulatory disorder and insulin resistance and diabetes are involved in its pathophysiology. Metformin, an anti‐diabetic agent, has been reported to be useful to induce ovulation.MethodsMetformin treatment was classified into four types: (1) clomiphene–metformin combination treatment for clomiphene‐resistant patients; (2) clomiphene–metformin combination for clomiphene‐sensitive patients; (3) clomiphene–metformin combination for naïve patients; and (4) metformin monotherapy. The patients underwent physical, endocrinological, and clinical examinations for their ovulation rates, pregnancy rates, and follicular development.ResultsThe ovulation rates, pregnancy rates, and single follicular development were not significantly different among the clomiphene–metformin combination treatment groups. In the Body Mass Index (BMI) subanalysis, the pregnancy rate was higher in the BMI≥30 kg/m2 group than in the other three groups with a BMI of ≤30 kg/m2 in both cycles and cases. The ovulation rates and pregnancy rates were significantly higher in the group with a fasting insulin of ≥15 μU/mL than in the groups with a fasting insulin of <15 μU/mL in both cycles and cases.ConclusionClomiphene–metformin combination treatment appears to be useful, at least for clomiphene‐resistant patients, and a BMI of >30 kg/m2 and a fasting insulin of ≥15 μU/mL appear to be predictors of a good result with this treatment.

show abstract

Nonobese women with polycystic ovary syndrome respond better than obese women to treatment with metformin

Cited by 142 publications

References 35 publications

Insulin and hyperandrogenism in women with polycystic ovary syndrome

Insulin and hyperandrogenism in women with polycystic ovary syndrome

Metformin improves polycystic ovary syndrome symptoms irrespective of pre-treatment insulin resistance

Clinical outcome of various metformin treatments for women with polycystic ovary syndrome

Contact Info

Product

Resources

About