Patient compliance has often hampered lifestyle change in the management of PCOS but lifestyle changes remain the mainstay of management for these patients.
I have always stressed the use of lifetstyle changes in my patients with PCOS and when combining this with Metformin have emphasised the fact that this is the best chance for patients to get on top of their Polycystic Ovarian syndrome and symptoms that are associated with this disease.
A recent meta-analysis published in the Human Reproduction update by Dr Negar Naderpoor (Monash University, Melbourne, Australia) and team, vailidates this practice, showing that metformin plus lifestyle change improved the menstrual cycle and lowered body mass index in women with PCOS better than lifestyle changes alone.
Metformin on its own gave similar benefits in BMI to those that used lifestyle measures alone.
This study suggests strongly that the combination has a strong role to play in weight management and ultimately PCOS control improving menstrual irregularities and ultimately fertility in these patients.
The work is published online June 9 in Human Reproduction Update by Dr Negar Naderpoor (Monash University, Melbourne, Australia) and colleagues.
“These findings provide strong evidence advocating the beneficial effects of metformin in addition to lifestyle intervention on metabolic and reproductive features of PCOS,” second author Dr Soulmaz Shorakae (Monash University). In particular, combining metformin with lifestyle modification might be beneficial “where compliance and sustainability with lifestyle modification are limited.”
The study however only included small small groups of subjects and future studies of appropriate size and duration are vital to clarify the role of metformin in PCOS management.”
According to national and international guidelines, metformin is not a recommended first-line treatment in the management of PCOS, but its use is recommended by many specialists and Colleges for certain symptoms of the syndrome or in cases where other treatment has failed.
The US Endocrine Society advises first-line treatment for menstrual abnormalities and hirsutism/acne associated with PCOS should be hormonal contraceptives.
Metformin is recommended in women who cannot take hormonal contraceptives.
65% to 80% of women with PCOS have insulin resistance and some argue that all women with PCOS do. This is considered the key feature of the syndrome.
Dr Shorakae said that “Excessive weight can exacerbate both metabolic and reproductive features of PCOS, leading to insulin resistance, impaired glucose tolerance, dyslipidemia, high androgen levels, ovulation dysfunction, and subfertility.”
“Metformin improves the insulin resistance in PCOS. Moreover, women with PCOS are at increased risk of type 2 diabetes where metformin would be the first-line therapy in addition to lifestyle modification.”
Modified by Naylin Appanna, Gynaecologist, Hamilton