Major finding on Polycystic Ovary Syndrome
13 Apr 2007
Medical researchers from the Jean Hailes Foundation for Women’s Health in Australia and Monash University have made a significant breakthrough in the treatment of a common hormone disorder affecting up to 10 per cent of women of reproductive age.
The finding confirms that lifestyle combined with metformin is likely to be the best option to lower insulin resistance and potentially protect against type 2 diabetes for women with Polycystic Ovary Syndrome (PCOS).
PCOS is a hormone disorder with increases in the hormone insulin. The elevated insulin causes symptoms including infertility, facial hair, diabetes and potentially an increased risk of heart disease.
While the causes of PCOS are not yet clear, recent studies show a woman’s level of physical activity, her diet and her genetics can be involved – as these all impact on the insulin hormone levels. The new findings reveal that metformin, used for more than 60 years to treat diabetes, has a greater role in the treatment of PCOS than previously thought.
In this study metformin lowered the levels of insulin and for the first time was shown to improve the symptoms of PCOS as effectively as conventional treatment with the oral contraceptive pill.
The findings revealed that for women with symptoms of PCOS, low-dose and high-dose contraceptives and metformin were all effective at treating symptoms. However, the high-dose Pill increased insulin levels, increasing future diabetes risk. The low-dose Pill had no effect on insulin and metformin considerably reduced insulin levels.
“Significantly, these results suggest that long-term use of the high-dose Pill for PCOS sufferers is not ideal as it increases insulin resistance, increasing diabetes risk,” Professor Teede says. “It’s extremely important for women with PCOS to change their lifestyles by incorporating regular physical activity into their daily routine and eating a well-balanced, low-fat diet with plenty of fresh vegetables and fruit. Lifestyle changes, as well as medication, are vital for a reduction in symptoms and insulin resistance.This is an important study which will help the medical profession and women choose the best clinical treatment for this common hormone disorder.”
Professor Teede’s findings were published in the international journal, Diabetes Care on February 28 2007.
Comment
There are actually very few studies that have been carried out and published concerning the use of insulin sensitising drugs as a treatment for PCOS. These suggest that it may well be useful in several areas: helping weight reduction, improving irregular periods (70%), normalising blood cholesterol and leading to ovulation.
One study looking at ovulation in particular found that, compared to no treatment, 34% of women ovulated taking metformin (compared to 4% who did not receive it) and when this was combined with clomifene it was as high as 90% (as compared to 8% in those who only received clomifene). These studies contained overweight women with PCOS - its role in treating women of normal weight has not been investigated. The most common side effects during treatment are diarrhoea, nausea, vomiting and abdominal bloating.
Shortcomings of the Studies
The studies that are available concerning the insulin-sensitising drugs are very exciting and will hopefully pave the way for a longer-term treatment for this disease, which can affect many different areas of a woman's life. It is important to realise, though, that the investigation is still at a very early stage. Long-term effects are not known - the longest follow up so far is for around 6 months of use.
What the Future Holds
Because of the lack of research using these drugs, many doctors are awaiting further studies to confirm their initial apparent success and identify potential side effects before jumping in and prescribing them. This is a safe and sensible approach. There may be specific cases when their use is considered appropriate at this stage, and this is something for an individual doctor to decide with the patient's full understanding of the present situation.
