Orlistat Is as Beneficial as Metformin in the Treatment of Polycystic Ovarian Syndrome

Abstract

This paper presents a 5-year follow-up of a randomized, controlled trial, which compared microwave endometrial ablation (MEA) with transcervical resection of the endometrium (TCRE) for women with heavy menstrual bleeding. Two hundred sixty-three women were randomized to receive either MEA (n ϭ 129) or TCRE (n ϭ 134). For the current study, participants who were at least 60 months postprocedure were sent a questionnaire concerning satisfaction with and acceptability of their treatment method, menstrual status, changes in health-related quality of life, and any further surgery received. This was the same questionnaire that had been sent at 1-and 2-years of follow-up.Two hundred thirty-six of the original 263 study participants (90%) returned a completed questionnaire, including 116 MEA patients and 120 TCRE patients. Total or general satisfaction was reported by significantly more of those who underwent MEA compared with those who had TCRE (86% vs. 74%). Similarly, 83% and 75%, respectively, reported a cure or acceptable improvement in their symptoms, 97% and 91% expressed overall treatment acceptance, and 97% and 89% said that they would recommend the procedure to a friend. Both groups had similar, significant improvement in bleeding and pain scores, and 96% overall reported amenorrhea or lighter periods. Significantly more women in the TCRE group experienced dyspareunia compared with the MEA group (11% vs. 6%, respectively). Premenstrual symptoms improved significantly for both groups.Quality-of-life scores were improved for all participants. Disruptions to work or leisure activities were significantly lower in both treatment groups.In all, 24% of the patients who had MEA and 28% of those who had TCRE had undergone further gynecologic surgery in the follow-up period. This includes a 16% hysterectomy rate for the MEA cohort and 25% hysterectomy rate for women who had TCRE. Nearly all of the 20 hysterectomies among women in the MEA arm occurred within 24 months of the initial procedure. Reasons for hysterectomy were bleeding, combined bleeding and dysmenorrhea, cyclic pain, and miscellaneous conditions, including 1 woman in the TCRE arm who was operated on for endometrial carcinoma. GYNECOLOGY Volume 60, Number 7 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT The authors performed a medical chart review of all women diagnosed with atypical squamous cells of undetermined significance (ASCUS) between July 2002 and February 2004 to determine the presence of oncogenic human papillomavirus (HPV) according to patient age. Other risk factors were also noted. Cervical smears were evaluated using fluid-based thin-layer cytology (PreservCyt; Cytyc Corp., Marlborough, MA). Office Gynecology 435 436 Obstetrical and Gynecological Survey ABSTRACT This paper presents a series of 970 women who reported to the Chronic Pelvic Pain Clinic at the University of North Carolina between July 1993 and December 2000 with pelvic pain of at least 6 months duration. The authors investigated the prevalence of irritable bowel syndrome (IBS) in th...

The effects of metformin or orlistat on obese women with polycystic ovary syndrome: a prospective randomized open-label study

“…Orlistat is an antiobesity drug, which has been shown to produce a significantly greater degree of weight loss than metformin [30]. Our study in agreement with Metwally study [31]showed that metformin has the same effect as orlistat on weight loss.…”

“…In another study, metformin reduced weight and waist circumference but did not affect testosterone level [39]. Jayagopal reported that metformin-treated subjects presented the same reduction in testosterone concentration as cases treated with orlistat, although the weight loss was much less in metformin group than orlistat-treated patients [30]. The effects of metformin treatment in terms of hyperandrogenemia are various.…”

“…The other randomized studies have also tried to compare the effects of orlistat and metformin in obese PCOS patients, but they have not reported the ovulation rate and had a small number of cases [29,30]. In a randomized study the effects of orlistat and metformin were compared in obese anovulatory patients regardless of the presence or absence of PCOS and the results showed no significant difference in ovulation rate between orlistat and metformin [31].…”

Ovarian function and obesity—Interrelationship, impact on women's reproductive lifespan and treatment options

“…Data from the recent studies on the use of sibutramine in obese patients with PCOS clearly show that treatment with this drug for 6 months together with lifestyle intervention, results in weight reduction and may also decrease hyperandrogenaemia and IR (Sabuncu et al, 2003;Florakis et al, 2008;Lindholm et al, 2008). Treatment with orlistat, a potent inhibitor of gastric and pancreatic carboxyl-ester lipase which impairs digestion of dietary fats, combined with hypo-caloric diet apart from decreasing body weight also led to a reduction of serum insulin and androgen levels in obese PCOS patients (Jayagopal et al, 2005;Diamanti-Kandarakis et al, 2007a;Panidis et al, 2008).…”

Obesity Management in Women with Polycystic Ovary Syndrome

“…In one study, sibutramine produced significant weight loss and reduction in hyperandrogenism in 40 obese PCOS women after 5 months of treatment [114]. Similarly, treating PCOS women with orlistat resulted in weight loss and reduction in testosterone [115]. However, as these studies were not placebo-controlled, the placebo weight loss effect of these drugs on PCOS women remains unknown.…”