Metformin in polycystic ovary syndrome: systematic review and meta-analysis.
OBJECTIVE
To assess the effectiveness of metformin in improving clinical and biochemical features of polycystic ovary syndrome.


METHODS
Systematic review and meta-analysis.


METHODS
Randomised controlled trials that investigated the effect of metformin compared with either placebo or no treatment, or compared with an ovulation induction agent.


METHODS
13 trials were included for analysis, including 543 women with polycystic ovary syndrome that was defined by using biochemical or ultrasound evidence.


METHODS
Pregnancy and ovulation rates. Secondary outcomes of clinical and biochemical features of polycystic ovary syndrome.


RESULTS
Meta-analysis showed that metformin is effective in achieving ovulation in women with polycystic ovary syndrome, with odds ratios of 3.88 (95% confidence interval 2.25 to 6.69) for metformin compared with placebo and 4.41 (2.37 to 8.22) for metformin and clomifene compared with clomifene alone. An analysis of pregnancy rates shows a significant treatment effect for metformin and clomifene (odds ratio 4.40, 1.96 to 9.85). Metformin has an effect in reducing fasting insulin concentrations, blood pressure, and low density lipoprotein cholesterol. We found no evidence of any effect on body mass index or waist:hip ratio. Metformin was associated with a higher incidence of nausea, vomiting, and other gastrointestinal disturbance.


CONCLUSIONS
Metformin is an effective treatment for anovulation in women with polycystic ovary syndrome. Its choice as a first line agent seems justified, and there is some evidence of benefit on variables of the metabolic syndrome. No data are available regarding the safety of metformin in long term use in young women and only limited data on its safety in early pregnancy. It should be used as an adjuvant to general lifestyle improvements and not as a replacement for increased exercise and improved diet.
Department of Endocrinology and Metabolism, Peninsula Medical School, South West Centre for Reproductive Medicine, Derriford Hospital, Plymouth, Devon, PL6 8DH. jonathan.lord@pms.ac.uk
Jonathan M
JM
Lord
Ingrid H K
IH
Flight
Robert J
RJ
Norman
D001794:Blood Pressure / Q000187:drug effects; D001835:Body Weight; D004311:Double-Blind Method; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood; D008687:Metformin / Q000627:therapeutic use*; D010060:Ovulation / Q000187:drug effects; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000188:drug therapy*; D011247:Pregnancy / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D016037:Single-Blind Method; D016896:Treatment Outcome
D005300:Fertility Agents, Female; D007328:Insulin; D008055:Lipids; D008687:Metformin