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Adding metformin to oral contraceptive may be beneficial for women with PCOS

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ASRM Annual Meeting

Combining metformin with oral contraceptives lowered LDL and tumor necrosis factor levels, mitigated triglyceride increases and enhanced beta cell and endothelial function in some women with polycystic ovary syndrome, results from two studies suggest.

In one open clinical trial, researchers randomly assigned 50 women with polycystic ovary syndrome to receive 30 mcg ethinylestradiol and 2 mg chlormadinone acetate or the same regimen plus with 875 mg of metformin daily. The women were followed for 12 months.

The researchers noted reductions in carotid stiffness index among women receiving oral contraceptives only compared with those receiving combination therapy after 12 months (P=.02). Systolic arterial pressure also increased among the combination group during the first 6 months compared with women receiving oral contraceptives alone (P=.02).

Results indicated that LDL and tumor necrosis factor (TNF) levels declined in the combination arm during follow-up (P<.01). Triglycerides levels also increased by 75% in the oral contraceptive only group compared with 33% in women receiving oral contraceptives and metformin.

Combination therapy, however, did not appear to improve arterial function and structure in this population.

A second study involved 19 overweight women (mean age, 24.9 years; mean BMI, 33.7) who had PCOS. Researchers selected an oral contraceptive containing 35 mcg of ethinyl estradiol and 0.18/0.215/0.25 mg of norgestimate (Ortho-Tricyclen, Ortho-McNeil) and randomly assigned participants to a 3-month treatment course of metformin plus oral contraceptive or oral contraceptive alone.

Women receiving combination therapy demonstrated considerable weight loss by the study’s conclusion compared with those receiving oral contraceptive only. Women in the combination group also experienced a 19% increase in acute insulin response to glucose (P=.016) and a 69% increase in brachial artery flow-mediated dilation (P=.01).

The treatment courses, however, differed little in their effects on androgen levels, lipid profile, insulin sensitivity and most serum inflammatory markers.

Combination therapy with metformin and an oral contraceptive may be more appropriate and advantageous in overweight women with PCOS who are unconcerned with fertility, as the treatment may reduce cardiovascular risks associated with oral contraceptive use by enhancing beta cell and endothelial function, the researchers concluded.

For more information:

• Stovall DW. P-311.
• Viera CS. O-217. Both presented at: 66^th Annual Meeting of the American Society of Reproductive Medicine; Oct. 23-27, 2010; Denver.

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