title: Metformin to restore normal menses in oligo-amenorrheic teenage girls with polycystic ovary syndrome (PCOS).
abstract: OBJECTIVE
  To describe our clinical experience in using Metformin combined with a high protein-low carbohydrate diet to restore normal menstrual cycles in teenaged females with polycystic ovary syndrome (PCOS).
  
  
  METHODS
  To enter the study, patients had to have well-documented PCOS, be oligo- (six cycles or less in the preceding year) or amenorrheic (absence of menstrual cycles for 1 year), and not have exclusionary diseases or drugs. Accompanying a high protein-low carbohydrate diet, Metformin (1.5-2.55 g/day) was given for 10.5 +/- 6.4 months (range, 4.5-26.5 months). Follow-up every 8-10 weeks for > or =6 months was scheduled with interval history, review of menstrual status, assessment of any Metformin-related side effects, brief physical examination, and determination of weight and blood pressure.
  
  
  RESULTS
  All 11 girls had normal fasting blood glucose and glycohemoglobin. Pre-Metformin, five girls were amenorrheic, three had only one menstrual cycle in the previous year, and three had > or =6 cycles/year. With Metformin, 10 of 11 girls (91%) resumed regular normal menses; 39% of 38 follow-up visits with regular normal menstrual cycles were ovulatory with normal luteal-phase serum progesterone (> or =2.3 ng/mL). Of the 11 girls, nine (82%) lost weight; five girls lost > or =11 lb and seven lost > or =5 lb. After adjusting for weight reduction, with Metformin, estradiol and progesterone rose (p =.0014,.027, respectively) (changes consistent with resumption of regular normal menses), total plasma cholesterol fell (p =.026), and there was a downward trend in testosterone (p =.068).
  
  
  CONCLUSIONS
  Metformin safely ameliorates the endocrinopathy of PCOS in previously oligo-amenorrheic teenage females with PCOS, facilitating resumption of normal menses in most girls.
authors.affiliation: Cholesterol Center, Jewish Hospital and Molecular Diagnostics Laboratories, Cincinnati, Ohio 45229, USA. glueckch@healthall.com
authors.forename: C J
authors.initials: CJ
authors.lastname: Glueck
authors.forename: P
authors.initials: P
authors.lastname: Wang
authors.forename: R
authors.initials: R
authors.lastname: Fontaine
authors.forename: T
authors.initials: T
authors.lastname: Tracy
authors.forename: L
authors.initials: L
authors.lastname: Sieve-Smith
mesh_terms: D000293:Adolescent; D000568:Amenorrhea / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy* / Q000235:genetics; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D015331:Cohort Studies; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D008598:Menstruation / Q000187:drug effects*; D008687:Metformin / Q000494:pharmacology / Q000627:therapeutic use*; D009765:Obesity / Q000150:complications / Q000209:etiology; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications* / Q000175:diagnosis
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004044:Dietary Proteins; D012739:Gonadal Steroid Hormones; D007004:Hypoglycemic Agents; D008055:Lipids; D008687:Metformin