title: Association of oral contraceptive and metformin did not improve insulin resistance in women with polycystic ovary syndrome.
abstract: OBJECTIVE
  
  
  
  OBJECTIVE
  to compare clinical and laboratory parameters in women with polycystic ovary syndrome (PCOS) using metformin or combined oral contraceptive (COC) after 6 months.
  
  
  METHODS
  retrospective study analyzing records of patients with PCOS using the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society criteria. The groups were: I-COC (21 tablets, pause of 7 days; n=16); II-metformin (850 mg 12/12h, n=16); III-COC plus metformin (n=9). Body mass index (BMI), acne (% of improvement), modified Ferriman-Gallway index and menstrual cycle index (MCI), luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (TT), androstenedione (A) and homeostasis model assessment: insulin resistance (HOMA-IR) index were assessed Results: isolated use of COC compared to metformin was better regarding to acne, Ferriman index, MCI, LH, TT and A levels. On the other hand, metformin was better in the HOMA-IR index (4.44 and 1.67 respectively, p=0.0007). The association COC plus metformin, compared to metformin alone shows the maintenance of improvement of acne, Ferriman index, MCI, and testosterone levels. The HOMA-IR index remained lower in the metformin alone group (4.19 and 1.67, respectively; p=0,046). The comparison between COC plus metformin and COC alone, in turn, shows no difference in the improvement of acne, Ferriman index, MCI, LH, TT and A levels, indicating that the inclusion of metformin did not lead to additional benefits in these parameters. Still, the HOMA-IR index was similar in both groups (4.19 and 4.44 respectively; p=0.75), showing that the use of metformin associated with COC may not improve insulin resistance as much as it does if used alone.
  
  
  CONCLUSIONS
  our data suggest that the combination of metformin and contraceptive does not improve insulin resistance as observed with metformin alone.
authors.affiliation: Department of Gynecological Endocrinology, Gynecology Division, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Margareth Chiharu
authors.initials: MC
authors.lastname: Iwata
authors.affiliation: Unifesp, São Paulo, SP, Brazil.
authors.forename: Livia
authors.initials: L
authors.lastname: Porquere
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Isabel C Espósito
authors.initials: IC
authors.lastname: Sorpreso
authors.affiliation: HC, FM, USP, São Paulo, SP, Brazil.
authors.forename: Edmund C
authors.initials: EC
authors.lastname: Baracat
authors.affiliation: HC, FM, USP, São Paulo, SP, Brazil.
authors.forename: José Maria
authors.initials: JM
authors.lastname: Soares Júnior
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy; D015992:Body Mass Index; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007333:Insulin Resistance; D007986:Luteinizing Hormone / Q000097:blood; D008597:Menstrual Cycle / Q000187:drug effects; D008687:Metformin / Q000627:therapeutic use*; D011085:Polycystic Ovary Syndrome / Q000378:metabolism*; D012189:Retrospective Studies; D013739:Testosterone / Q000097:blood
chemical_list: D003277:Contraceptives, Oral, Combined; D007004:Hypoglycemic Agents; D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D008687:Metformin