Both metformin and combined oral contraceptives are both well tolerated and effective treatments for acne, hirsutism, and menstrual-cycle control in adolescent women with polycystic ovary syndrome (PCOS), according to results of a prospective study presented here on June 15 at the 31st Annual Meeting of the European Society for Human Reproduction and Embryology (ESHRE) If the main patient complaints are limited to acne and hirsutism, investigators led by Aboubakr Elnashar, MD, Benha University Hospital, Mansoura, Egypt, found metformin to be advantageous, as it has the safer profile between the 2 options. Conversely, Dr. Elnashar added, “If the main aim is menstrual-cycle control, combined oral contraceptives have clear advantages in terms of effectiveness and cost.” The main therapeutic goals of treating adolescent PCOS are to reduce signs of hyperandrogenism (including hirsutism) and to obtain regulation of the menstrual cycle. Dr. Elnashar and colleagues set out to examine and compare metformin and combined oral contraceptives over 24 months, to provide the longest follow-up of these patients to date. The team defined adolescent PCOS as oligomenorrhoea (<6 cycles="" year="" and="" serum="" testosterone="">1 microg/mL occurring in women ages 15 to 20 years old. The investigators randomised subjects to no-treatment control (n = 39), metformin 1700 mg/day (n = 40), or low-dose combined oral contraceptives ethinyl oestradiol 30 microg and progestin 15 mg (n = 40). For trial completers at 24 months, there was no change in menstrual-cycle regularity for control subjects, but there were similar significant improvements (P < .05) compared with control subjects for metformin (92.5%) and combined oral contraceptives (100%). Similarly, there was subjective improvement only for hirsuitism in control subjects compared with the improvements in subjects taking metformin (25%) and combined oral contraceptives (40%). There was a small continuous increase over the 24 months (+0.3 microg/mL) for serum testosterone in control subjects, while, over the first 6 months, both metformin and combined oral contraceptives demonstrated significant decreases (-0.7, -0.3 microg/mL; P < .05). This difference was essentially lost after 24 months of metformin (-0.3 microg/mL), but was maintained after 24 months of combined oral contraceptives (-0.6 microg/mL; P < .05). Insulin sensitivity was specifically improved for subjects taking metformin (glucose infusion rate [GIR]: +0.5, P < .05), while this measure dropped for both control subjects (-0.8) and those taking combined oral contraceptives (-1.3; P < .05). Similarly, after-load serum insulin levels decreased with metformin (-62 microIU/mL; P < .05), and increased for control subjects (11 microIU/mL) and those taking combined oral contraceptives (+84 microIU/mL; P < .05). Dr. Elnashar and colleagues observed similar benefits for metformin for weight loss (-15 kg; P < .05), with non-significant weight increases with control subjects (+15 kg) and those taking combined oral contraceptives (+7 kg). Mean baseline characteristics were similar across the groups: 17 years old, weight 87 kg, serum testosterone 1.3 microg/mL, fasting insulin 16.2 microIU/L, after-load serum insulin 110 microIU/L, and GIR 4.1. The increasing number of young women with adolescent PCOS has been linked with increased prevalence of obesity. There is also evidence that these patients can show a progressive course, with the potential to develop into full-blown adult PCOS.
LISBON, Portugal - June 17, 2015[Presentation title: RCT of the Effects of Metformin Vs. COCs in Adolescent PCOS Women Through a 24 Month Follow Up Period. Abstract O-010]