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Randomized Controlled Trial
. 2008 Nov;93(11):4299-306.
doi: 10.1210/jc.2008-0461. Epub 2008 Aug 26.

The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials

Kathleen Hoeger  1 , Kristen Davidson, Lynda Kochman, Tracy Cherry, Laurie Kopin, David S Guzick
Affiliations
Randomized Controlled Trial

The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials

Kathleen Hoeger et al. J Clin Endocrinol Metab. 2008 Nov.

Abstract

Context: Polycystic ovary syndrome (PCOS) presents in adolescence, and obesity is a common finding. The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear.

Objective: We investigated the effects of metformin, oral contraceptives (OCs), and/or lifestyle modification in obese adolescent women with PCOS.

Design: Two small, randomized, placebo-controlled clinical trials were performed.

Patients and participants: A total of 79 obese adolescent women with PCOS participated.

Interventions: In the single treatment trial, subjects were randomized to metformin, placebo, a lifestyle modification program, or OC. In the combined treatment trial, all subjects received lifestyle modification and OC and were randomized to metformin or placebo.

Main outcome measures: Serum concentrations of androgens and lipids were measured.

Results: Lifestyle modification alone resulted in a 59% reduction in free androgen index with a 122% increase in SHBG. OC resulted in a significant decrease in total testosterone (44%) and free androgen index (86%) but also resulted in an increase in C-reactive protein (39.7%) and cholesterol (14%). The combination of lifestyle modification, OC, and metformin resulted in a 55% decrease in total testosterone, as compared to 33% with combined treatment and placebo, a 4% reduction in waist circumference, and a significant increase in HDL (46%).

Conclusions: In these preliminary trials, both lifestyle modification and OCs significantly reduce androgens and increase SHBG in obese adolescents with PCOS. Metformin, in combination with lifestyle modification and OC, reduces central adiposity, reduces total testosterone, and increases HDL, but does not enhance overall weight reduction.

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Figures

Figure 1
Figure 1
A 24-wk change in SHBG for those completing the lifestyle treatment arm of the single treatment study separated by weight loss (n = 4 in each arm).
Figure 2
Figure 2
A 24-wk change in PAI-1 for those completing the lifestyle treatment arm of the single treatment study separated by weight loss.
See this image and copyright information in PMC

Comment in

References

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