| Metformin and Weight Loss in Women With PCOS The first choice of treatment for overweight and obese patients with PCOS is a change of lifestyle aimed at weight loss. Diet and exercise resulting in weight loss comprise the most successful strategy to improve reproductive and metabolic parameters of PCOS. Several studies have demonstrated that even a 5-10% loss in bodyweight can restore menstrual cyclicity and ovulation. It has been suggested that a diet of increased protein intake at the expense of carbohydrates could be more favorable than other diets with regard to the improvement of insulin sensitivity, weight reduction and maintenance of weight loss in patients with PCOS. Exercise as the only intervention has also been demonstrated to improve fertility, insulin sensitivity and cardiopulmonary functional capacity in women with PCOS. It has been proposed that women with PCOS benefit from metformin therapy. Metformin is a biguanide that inhibits the production of hepatic glucose, thereby decreasing insulin secretion, and enhances insulin sensitivity in peripheral tissues. Metformin improves the efficacy of lifestyle modifications resulting in weight loss and reduction in visceral fat. There is evidence of a beneficial effect of metformin on the menstrual pattern and hormone levels in patients with PCOS. However, in clomiphene-resistant patients, metformin increases the ovulation frequency when added to clomiphene. Metformin treatment has also been used in patients with PCOS during pregnancy. A placebo controlled study in 40 patients demonstrated reduced pregnancy-related complications, such as preterm delivery and pre-eclampsia, in the metformin group when compared with the placebo. In other prospective but uncontrolled studies, metformin has been demonstrated to reduce the frequency of miscarriages and gestational diabetes in women with PCOS. Recently, a placebo-controlled study involving 29 patients with PCOS confirmed the finding of a reduced abortion risk. A meta-analysis of eight studies did not find any evidence for adverse pregnancy outcome in PCOS women undergoing treatment with metformin.
changes should always be the first-line strategy in the management of obese patients to improve fertility. Combined treatment with metformin or anti-obesity drug therapy may also be considered. In patients with severe obesity, bariatric surgery appears to be the most effective therapy to lose weight and to improve fertility. |
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| Aesthetic Medicine Today |
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