title: Clinical, endocrine and metabolic effects of metformin added to ethinyl estradiol-cyproterone acetate in non-obese women with polycystic ovarian syndrome: a randomized controlled study.
abstract: BACKGROUND
  Oral contraceptive pills (OC) are usually the first choice of treatment for polycystic ovarian syndrome (PCOS), when fertility is not desired. However, they do not improve, or may even further induce impairment of insulin sensitivity, which is already impaired in women with PCOS. In this prospective, randomized study, we analysed the additional benefits of adding metformin to the OC treatment in non-obese women with PCOS.
  
  
  METHODS
  After a baseline work-up including body mass index (BMI), waist:hip ratio (WHR), Ferriman-Gallwey score, ovarian volume, serum gonadotrophin, androgen and sex hormone-binding globulin (SHBG) levels, and fasting lipid, glucose and insulin levels, 40 non-obese women with PCOS were assigned either to the OC or to the OC + metformin treatment by computer-assisted randomization. At the end of the 4 month follow-up period, subjects were re-evaluated.
  
  
  RESULTS
  The two groups were similar at baseline. After treatment, women in the OC + metformin group had significant decreases in BMI and WHR, and a significant increase in insulin sensitivity, in contrast to those in the OC group, who had insignificant changes in these parameters. Adding metformin also caused significant improvements in serum androstenedione and SHBG levels compared with the OC treatment alone.
  
  
  CONCLUSIONS
  Adding metformin to the OC treatment may improve the insulin sensitivity, and may further suppress the hyperandrogenaemia in non-obese women with PCOS.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Marmara University School of Medicine, Istanbul, Turkey. korayelter@marmara.edu.tr
authors.forename: Koray
authors.initials: K
authors.lastname: Elter
authors.forename: Gonca
authors.initials: G
authors.lastname: Imir
authors.forename: Fatih
authors.initials: F
authors.lastname: Durmusoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000735:Androstenedione / Q000097:blood; D001824:Body Constitution; D015992:Body Mass Index; D017373:Cyproterone Acetate / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004997:Ethinyl Estradiol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008687:Metformin / Q000627:therapeutic use*; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D011446:Prospective Studies; D012738:Sex Hormone-Binding Globulin / Q000032:analysis
chemical_list: D012738:Sex Hormone-Binding Globulin; D000735:Androstenedione; D004997:Ethinyl Estradiol; D017373:Cyproterone Acetate; D008687:Metformin