Evaluating the effect of insulin sensitizers metformin and pioglitazone alone and in combination on women with polycystic ovary syndrome: An RCT|
Sohrevardi, Seyed Mojtaba; Nosouhi, Fahime; Khalilzade, Saeed Hossein; Kafaie, Parichehr; Karimi-Zarchi, Mojgan; Halvaei, Iman & Mohsenzadeh, Mehdi
Background: Insulin resistance and hyperinsulinemia may play a role in
pathogenesis of PCOS. One of the common therapeutic methods is using insulinsensitizing
drugs such as metformin and thiazolidinediones.
Objective: The purpose was to determine the effect of metformin and pioglitazone
on clinical, hormonal and metabolic parameters in women with PCOS.
Materials and Methods: Eighty four women randomly received one of the
following for 3 months: metformin (n=28) (500 mg three times a day), pioglitazone
(30 mg daily) (n=28) and combination of both metformin and pioglitazone (n=28)
(30 mg/day pioglitazone plus 500 mg metformin three times a day). Hormonal
profile, fasting serum insulin, body weight, body mass index, menstrual status and
waist to hip ratio were evaluated before and after treatment.
Results: Metformin and pioglitazone and combination therapy induced favorable
changes in fasting serum insulin, HOMA-IR index, QUICKI, fasting glucose to
insulin ratio in women with PCOS. Body weight, BMI, and waist to hip ratio
increased significantly after treatment with pioglitazone but the data were similar
after administration of metformin or combination therapy. Total testosterone level
decreased significantly only after treatment with metformin. After 3 months in
patients who received pioglitazone or combination therapy, menstrual cycles became
regular in 71.4% and 73.9% respectively. While menstrual improvement happened
only in 36.4% of the patients treated with metformin.
Conclusion: These findings suggest that insulin-sensitizing drugs induce beneficial
effect in insulin resistance and menstrual cyclicity but only metformin ameliorated
hyperandrogenemia in women with PCOS. Treatment with combination of
metformin and pioglitazone did not show more benefit than monotherapy with each
Polycystic ovary syndrome; Metformin; Pioglitazone; Insulin resistance.