ABSTRACT
PCOS is a heterogeneous clinical syndrome characterized by a spectrum of symptomatology, pathology and laboratory findings. It is now accepted that polycystic ovary syndrome has important long-term health implications, including metabolic disorders and increased risk factors for cardiovascular disease like insulin resistance, abdominal obesity, dyslipidemia, hypertension and markers of abnormal vascular function. The aim of this work was to study the effect of metformin on the clinical, metabolic and endocrine parameters in hirsute women secondary to polycystic ovary syndrome. The study was conducted on 30 Egyptian hirsute patients suffering from polycystic ovary syndrome. Clinical examination included anthropometric measurements [BMI and WHR] and Ferriman and Gallwey scoring for hirsutism. Fasting serum insulin and fasting blood glucose were measured from which insulin resistance [IR] was assessed by HOMA. The glucose to insulin ratio [GIR] was calculated. Lipid profile was estimated. Serum luteinizing hormone [LH] and follicle stimulating hormone [FSH] were estimated in the early follicular phase. Total serum testosterone and sex hormone-binding globulin [SHBG] were measured. Ultrasonographgy was done on the pelvis for examination of the ovaries. The patients were instructed to do diet and physical exercise. They received metformin 1500 mg/day for 6 successive months. Clinical, metabolic and endocrine parameters were reevaluated after the medication. A significant 31% improvement in the frequency of the menstrual cycle was observed. Hirsutism improved by 19%. BMI was reduced by 8%. WHR decreased by 2.3%. Insulin resistance decreased by 54%. Total serum cholesterol, LDL-cholesterol, serum triglyceride and total cholesterol/H DL-cholesterol ratio showed slight decrease [3%, 6%, 9% and 9%, respectively], while HDL-cholesterol showed a slight increase by 7%. Total serum testosterone decreased by 32% and LH/FSH ratio improved by 28%. SHBG levels increased by 9%. There was a positive correlation between BMI and HOMA-IR, serum cholesterol and serum TG. There was a highly significant positive correlation between BMI and FBG as well as fasting serum insulin and HOMA-IR. On the other hand, there was a significant negative correlation between BMI and GIR. A highly significant positive correlation was found between BMI and total cholesterol and TG. Also, there was a significant positive correlation between BMI and total cholesterol/HDL-cholesterol ratio. Again, BMI showed a highly significant positive correlation with LH/FSH ratio. There was a highly significant positive correlation between WHR and the frequency of the menstrual cycle and fasting serum insulin. There was a significant positive correlation between WHR and HOMA-IR, serum total cholesterol and TG. There was a significant negative correlation between WHR and SHBG. HOMA-IR showed a significant positive correlation with GIR. Metformin improves insulin sensitivity and hyperandrogenemia in Egyptian hirsute women with polycystic ovary syndrome. This is associated with improvement in menstrual abnormalities. Metformin has additional benefit in reducing hair growth in Egyptian hirsute young women with polycystic ovary syndrome