Position
Statements
Metaformin
and Intervention in Polycystic Ovary Syndrome
Statement prepared by RJ Norman, W. Kidosn, M. Zaccharin
Prepared
on behalf of the Endocrine Society of Australia, Australian
Diabetes Society, Australasian Paediatric Endocrine Group, and Australasian
Society for the Study of Obesity.
Polycystic ovary
syndrome (PCOS) is an important condition associated with
menstrual abnormalities, infertility, weight disorders, diabetes
mellitus and consequences of excess androgen production and hyperlipidaemia.
Insulin resistance is commonly found in these patients and may contribute
to the disordered ovarian function. Reduction of insulin resistance
is of clinical value and is best achieved in the first instance
by life-style modification, mainly to achieve weight loss via diet
and exercise. Drugs that improve insulin sensitivity, such as metformin,
may play an increasing role in management in the future although
definitive evidence for clinical efficacy is scanty. Metformin should
only be tried after advice on life-style modification for women
who are anovular or have menstrual irregularities. Only a small
proportion of anovulatory women may be expected to respond on metformin
alone and addition of clomiphene citrate may be of value. Metformin
has not yet been proven to reduce hirsutism, improve the lipid abnormalities
of PCOS or reduce longer-term complications in this condition. Because
of the relative safety and cost of this drug, as well as the possible
long-term benefits of the reduction of insulin resistance, metformin
may prove to be of benefit following more evidence from properly
planned randomised controlled trials.
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