Jan. 2, 2008

NEW REVIEW: Metformin for the Treatment of PCOS

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By Sathya Achia Abraham

Video Clip #1 - "It's important that when a woman has PCOS that her physician screen her for what we call glucose intolerance.."
Video Clip #2 - "..it would be optimal if we could treat a woman with PCOS with drugs that might prevent the development of diabetes.."

A review published in Thursday's issue of The New England Journal of Medicine offers physicians improved treatment guidelines for women with polycystic ovary syndrome, the leading cause of infertility in American women.

In the review, featured in the Clinical Therapeutics section of the journal, John Nestler, M.D., vice chair of the Department of Internal Medicine and chair of the Division of Endocrinology and Metabolism at the Virginia Commonwealth University School of Medicine, highlighted a case study of a 23 year-old-woman with polycystic ovary syndrome, or PCOS, a disorder of the endocrine system that affects as many as 5 million women. He discusses the use of the insulin-sensitizing drug, metformin, for the treatment of PCOS and outlines its benefits, side effects, and areas of uncertainty.

Polycystic ovary syndrome causes hormonal imbalances leading to irregular menstrual cycles, excess facial and body hair, weight gain and adult acne. Women with PCOS are at high risk for developing Type 2 diabetes, and are also at increased risk for cardiovascular disease. 

"Over the past 10 years, the long-term treatment of PCOS has changed considerably with appreciation of the disorder's association with insulin resistance and substantial long-term metabolic risks," Nestler said.

"Treatment with metformin often addresses not only the traditional goals of therapy, such as amelioration of irregular menstrual cycles and signs of androgen excess, but also the new goals of retarding progression to Type 2 diabetes and early cardiovascular disease," he said.

In the 1980s, Nestler was among the first scientists in the world to suggest that insulin was an important reproductive hormone. His pioneering work to induce ovulation through the use of such insulin-sensitizing drugs as metformin has led to the common use of metformin to treat infertility in women with PCOS. In 1998, in an article in the New England Journal of Medicine, Nestler's research team was the first to publish findings on the combination therapy of metformin and clomiphene to promote ovulation.

This work was supported by grants from the National Institutes of Health.