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Is metformin the treatment of choice for anovulation in polycystic ovary syndrome?

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 440–441 (2007)Cite this article

The key clinical features of polycystic ovary syndrome (PCOS) are hyperandrogenism (i.e. hirsutism, acne, and alopecia) and menstrual irregularity, with associated anovulatory infertility.1 PCOS is also associated with metabolic dysfunction, which can result in an increased risk of type 2 diabetes mellitus and cardiovascular disease. Although women with polycystic ovaries are more insulin-resistant than weight-matched women with normal ovaries are, insulin resistance is only seen in 10–15% of slim (BMI 20–25 kg/m2) and 20–40% of obese (BMI ≥30 kg/m2) women with PCOS.2 Indeed, the consensus definition of PCOS recognizes obesity as an association (rather than a diagnostic criterion) of the syndrome because only 40–50% of women with PCOS are overweight.1

Ovarian hyperandrogenism is driven primarily by elevated levels of luteinizing hormone in slim women, whereas in overweight individuals (BMI >25 kg/m2) insulin can augment the effects of luteinizing hormone by acting as a co-gonadotropin. Obesity has a profound effect on both natural and assisted conception, and influences the chance of becoming pregnant and the likelihood of a healthy pregnancy.3 It seems logical to assume, therefore, that insulin-lowering and insulin-sensitizing treatments might improve the symptoms and reproductive outcomes of women with PCOS.4 As a result, metformin therapy has been heralded as the 'holy grail' in the management of PCOS because this agent gets to the heart of insulin resistance—one of the key pathophysiologic abnormalities of the syndrome, for those who are overweight. Metformin inhibits hepatic production of glucose, enhances insulin sensitivity at the cellular level, and also seems to have direct effects on ovarian function.

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  1. Reproductive Medicine Unit, Leeds General Infirmary, Belmont Grove, Leeds LS2 9NS, UK adam.balen@leedsth.nhs.uk

Authors and Affiliations

  1. AH Balen is a Professor of Reproductive Medicine and Surgery in the Reproductive Medicine Unit, Leeds General Infirmary, Leeds, UK.,

    Adam H Balen

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Balen, A. Is metformin the treatment of choice for anovulation in polycystic ovary syndrome?. Nat Rev Endocrinol 3, 440–441 (2007). https://doi.org/10.1038/ncpendmet0511

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