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Lifestyle changes plus metformin linked to weight loss, improved symptoms for PCOS
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A combination of lifestyle changes plus metformin in women with polycystic ovary syndrome may lead to better rates of weight loss and greater clinical improvements than lifestyle modification alone, according to research in Human Reproduction Update.
In a systematic review and meta-analysis of studies comparing lifestyle changes and metformin use in women with PCOS, researchers found that women who added metformin to lifestyle changes had more weight loss, lower BMI and improved menstruation compared with those assigned lifestyle changes and placebo.
Helena Teede
“Lifestyle intervention is currently first-line treatment for women with PCOS in both prevention of weight gain and in weight loss,” Helena Teede, MBBS, PhD, FRACP, director of the Monash Centre for Health Research and Implementation at Monash University and president of the Endocrine Society of Australia, told Endocrine Today. “Women with PCOS are known to have higher rates of weight, greater rates of obesity and to have significant adverse health impacts from excess weight. However, engagement, efficacy and sustainability of lifestyle intervention have proven challenging.”
Teede, Negar Naderpoor, PhD, of Monash University, and colleagues analyzed data from 608 participants aged 12 to 39 years with PCOS across nine studies comparing lifestyle plus metformin use, lifestyle plus placebo or metformin alone. Study periods ranged from 3 to 12 months; most studies lasted 6 months. Researchers noted that nine studies assigned a combination of diet and exercise to participants for lifestyle modification; three studies assigned only dietary advice; researchers in two studies also provided behavioral education and support. A dietitian individualized diets for participants in most studies, mostly based on a reduction of 500 kcal. The metformin dose across studies ranged from 1.5 g to 2 g daily; researchers used gradual dose escalation in seven trials.
Researchers found that lifestyle modifications plus metformin was linked to a lower BMI vs. lifestyle modification plus placebo, with a mean difference of –0.73 kg/m² (n = 493; 95% CI, –1.14 to –0.32).
In three studies that assessed menstruation, the lifestyle modification plus metformin arms had a greater number of menstrual cycles during 6 months vs. the lifestyle plus placebo arms (mean difference, 1.06; P = .006). Two studies also showed decreased subcutaneous adipose tissue among participants assigned lifestyle modification plus metformin vs. lifestyle plus placebo, with a mean difference of –92.49 cm² (P = .01).
Studies on metformin alone compared with lifestyle plus placebo suggest similar effects on BMI, the researchers noted.
“This work, in the context of the extensive literature on metformin in diabetes prevention and management, and the increasing literature on positive impacts of metformin on weight, as well as the current Endocrine Society guidelines on the combination of pharmacotherapy with lifestyle in weight loss and maintenance, suggests that metformin has a role in addition to lifestyle in the management of PCOS,” Teede said.
“Moving forward, large-scale, well-designed studies need to explore the benefits and potential adverse effects of metformin in addition to lifestyle in the longer term in both lean and overweight women and across a broader range of clinical endpoints,” she said. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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