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Title: Metformin Seems to be Effective for Anovulation in Women with Polycystic Ovary Syndrome

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BMJ 2003;327:951.
10/27/2003 05:27:00 PM
By Joene Hendry

Metformin appears to be an effective treatment for anovulation in women with polycystic ovary syndrome, according to the findings of a meta-analysis. Jonathan M. Lord, specialist registrar at Peninsula Medical School, South West Centre for Reproductive Medicine, Devon, United Kingdom, and colleagues conducted a meta-analysis of 13 trials that included 543 women with biochemical or ultrasound evidence of polycystic ovary syndrome. They analysed ovulation rates and pregnancy as well as clinical and biochemical outcomes of polycystic ovary syndrome in women treated with metformin compared with placebo, no treatment, or an ovulation induction agent. Data from 7 trials indicates that metformin is effective in achieving ovulation in women with polycystic ovary syndrome (odds ratio 3.88) while data from 3 additional trials show that metformin and clomifene, compared with clomifene alone, was effective in achieving ovulation (odds ratio 4.41). The investigators identified a significant treatment effect on pregnancy rates for metformin and clomifene (odds ratio 4.40) in 3 trials but in data from 5 other trials they found no evidence of benefit with metformin compared with placebo (odds ratio 2.76). Data from 9 trials revealed that metformin significantly reduced the fasting insulin concentrations (weighted mean difference -5.37). In 2 trials, compared with placebo, metformin treatment resulted in a significant reduction in both systolic (weighted mean difference -9.07) and diastolic (weighted mean difference -5.69) blood pressure, but the investigators note these findings came from a population of only 47 women. Data from 3 trials (98 total participants) indicate that metformin significantly reduced low density lipoprotein cholesterol (weighted mean difference -0.44), but metformin showed no significant treatment effect on total cholesterol. The researchers report no evidence of any effect of metformin on body mass index or waist to hip ratio. Metformin therapy was associated with a higher incidence of nausea or vomiting (odds ratio 3.84), and other gastrointestinal disturbances (odds ratio 4.40), but no trial reported serious adverse events. "The meta-analysis shows that metformin is effective in achieving ovulation in women with polycystic ovary syndrome," the authors write, but add that, "experience of metformin in pregnancy has been limited [so] caution is necessary until its safety in the first trimester has been evaluated more fully." "Metformin should," the authors conclude, "always be used as an adjuvant to general life-style improvements and not as a replacement for increased exercise and improved diet."

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