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Metformin Decreases Serum C-Reactive Protein in Women With Polycystic Ovarian Syndrome

The insulin sensitising drug metformin appears to lower C-reactive protein (CRP) levels in women with polycystic ovary syndrome (PCOS), suggesting that CRP or other inflammation parameters could be used to evaluate treatment efficiency in these patients.

Low-grade chronic inflammation, as indicated by elevated levels of serum CRP, is linked to obesity, an increased risk of cardiovascular disease, and insulin resistance syndromes such as PCOS. Metformin has been shown to improve metabolic disturbances in patients with PCOS, but whether the beneficial effects of these improvements are reflected in CRP levels is unclear.

Laure Morin-Papunen, MD, with the Department of Obstetrics and Gynaecology at the University Hospital of Oulu, Finland, and colleagues studied 20 nonobese women [body mass index (BMI) 25 kg/m² or less] and 32 obese women (BMI 27 kg/m² or more) with PCOS. Participants received either metformin, 500 mg twice daily for 3 months, then 1000 mg twice daily for 3 months; or ethinyl estradiol (35 µ)-cyproterone acetate (2 mg) oral contraceptive pills.

At baseline, serum concentrations of CRP were significantly higher in obese women than in nonobese women (P < .001). Furthermore, values correlated to BMI and to a lesser extent waist-hip ratio, suggesting that elevated CRP levels may be related to obesity and not only to PCOS itself.

During metformin treatment, serum CRP levels decreased significantly at 6 months overall (P = .006) and to an even greater extent in obese subjects. In contrast, treatment with ethinyl estradiol-cyproterone acetate increased serum CRP levels significantly (P < 0.001).

"To our knowledge, this is the first study investigating the effect of oral contraceptive pill treatment on CRP," Dr. Morin-Papunen and colleagues note. "The results suggest that the oral contraceptive pill may have metabolic and cardiovascular disadvantages, especially in obese women with insulin resistance," they add.

"Future studies will show whether CRP or other inflammation parameters should be used as markers of treatment efficiency and improvement of metabolic disturbances in women with PCOS," they suggest.

J Clin Endocrinol Metab 2003;88:10:4649-4654. "Metformin reduces serum C-reactive protein levels in women with polycystic ovary syndrome"

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