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1.
Femina ; 49(10): 636-640, 20211031.
Article in Portuguese | LILACS | ID: biblio-1358198

ABSTRACT

Objetivo: Abordar atualizações referentes à terapia medicamentosa para indução da ovulação nas mulheres diagnosticadas com síndrome dos ovários policísticos (SOP). Métodos: Revisão de literatura por meio de levantamento bibliográfico do período de 1975 a 2021, nas bases eletrônicas PubMed, SciELO e MedLine, complementado pela Diretriz Internacional Baseada em Evidências para a Avaliação e Manejo da SOP de 2018 e pelo manual da Febrasgo para SOP. Sete descritores que atendessem à finalidade da pesquisa foram utilizados. Resultados: A literatura aponta atualmente algumas drogas como opção na terapêutica para a indução de ovulação, como metformina, letrozol e citrato de clomifeno, evidenciando que o uso de letrozol isolado e em associação com a metformina apresentaram melhores taxas de ovulação, 71,5% e 75,4%, respectivamente. Conclusão: O uso do letrozol isolado ou combinado com a metformina apresentou os melhores resultados nas taxas de gravidez e ovulação, todavia o tratamento para indução ovulatória deve ser individualizado.(AU)


Objective: To address updates of medicinal therapy for ovulation induction in women diagnosed with polycystic ovary syndrome (PCOS). Methods: Reviewing Literature through a bibliographic survey from 1975 to 2021, on the electronic databases PubMed, SciELO and MedLine, complemented by the International Evidence-Based Guideline for the Evaluation and Management of PCOS 2018 and the Febrasgo guide for PCOS. Seven descriptors that matched to the purpose of the research were applied. Results: Some drugs are currently indicated in the literature as an option for ovulation induction therapy, such as: metformin, letrozole and clomiphene citrate, showing that the use of letrozole alone and in association with metformin had better ovulation rates, 71.5% and 75.4%, respectively. Conclusion: The use of letrozole alone or combined with metformin showed the best results in pregnancy and ovulation rates, however, treatment for ovulatory induction must be individualized.(AU)


Subject(s)
Humans , Female , Ovulation Induction/methods , Polycystic Ovary Syndrome/drug therapy , Infertility, Female/drug therapy , Databases, Bibliographic , Clomiphene/therapeutic use , Letrozole/therapeutic use , Metformin/therapeutic use
2.
Chinese Medical Journal ; (24): 2882-2889, 2021.
Article in English | WPRIM | ID: wpr-921201

ABSTRACT

BACKGROUND@#Obesity and insulin resistance (IR) are common features of polycystic ovary syndrome (PCOS). Metformin (MET) increases insulin sensitivity, but it is associated with unsatisfactory weight loss. The glucagon-like peptide-1 receptor agonist exenatide has been shown to reduce weight and IR in patients with diabetes. This study aimed to explore the therapeutic effects of exenatide once-weekly (QW) combined with MET on body weight, as well as metabolic and endocrinological parameters in overweight/obese women with PCOS.@*METHODS@#Fifty overweight/obese women with PCOS diagnosed via the Rotterdam criteria were randomized to one of two treatment groups: MET (500 mg three times a day [TID]) or combination treatment (COM) (MET 500 mg TID, exenatide 2 mg QW) for 12 weeks. The primary outcomes were anthropometric changes associated with obesity, and the secondary outcomes included changes in reproductive hormone levels, glucose and lipid metabolism, and C-reactive protein.@*RESULTS@#Forty (80%) patients completed the study. COM therapy was superior to MET monotherapy in reducing weight (P = 0.045), body mass index (BMI) (P = 0.041), and waist circumference (P = 0.023). Patients in the COM group on an average lost 3.8 ± 2.4 kg compared with 2.1 ± 3.0 kg in the MET group. In the COM group, BMI and waist circumference decreased by 1.4 ± 0.87 kg/m2 and 4.63 ± 4.42 cm compared with 0.77 ± 1.17 kg/m2 and 1.72 ± 3.07 cm in the MET group, respectively. Moreover, levels of fasting glucose, oral glucose tolerance test (OGTT) 2-h glucose, and OGTT 2-h insulin were significantly lower with COM therapy than with MET (P < 0.050). Mild and moderate gastrointestinal reactions were the most common adverse events in both groups.@*CONCLUSIONS@#COM therapy was more effective than MET alone in reducing body weight, BMI, and waist circumference, and improving insulin sensitivity in overweight/obese women with PCOS, with acceptable short-term side effects.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT04029272. https://clinicaltrials.gov/ct2/show/NCT04029272.


Subject(s)
Exenatide/therapeutic use , Female , Humans , Metformin/therapeutic use , Obesity/drug therapy , Overweight , Polycystic Ovary Syndrome/drug therapy
4.
Rev. Assoc. Med. Bras. (1992) ; 65(9): 1144-1150, Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1041074

ABSTRACT

SUMMARY OBJECTIVE In view of the high incidence of polycystic ovary syndrome (PCOS) and the unsatisfactory therapeutic effects of dimethyldiguanide or clomifene citrate alone, our study aimed to investigate the therapeutic effects of dimethyldiguanide combined with clomifene citrate in the treatment of PCOS. METHODS A total of 79 patients with POCS and 35 healthy females were included, and endometrial biopsies were obtained. The sterol regulatory element-binding protein-1 (SREBP1) expression in endometrial tissues was detected by qRT-PCR. POC patients were randomly divided into group A (n=40) and group B (n=39). Patients in group A were treated with dimethyldiguanide combined with clomifene citrate, while patients in group B were treated with clomifene citrate alone. The number of mature follicles and cervical mucus score, follicular development rate and single follicle ovulation rate, cycle pregnancy rate, early miscarriage rate, ovulation rate, endometrial thickness, positive rate of three lines sign, follicle stimulating hormone level and luteinizing hormone level were compared between the two groups. RESULTS The expression level of SREBP1 was higher in PCOS patients than that in the healthy control. SREBP1 expression was inhibited after treatment, while the inhibitory effects of combined treatment were stronger than those of clomifene citrate alone. Compared with clomifene citrate alone, the combined treatment improved cervical mucus score, follicle development rate, single follicle ovulation rate, endometrial thickness, positive rate of three lines sign, and follicle-stimulating hormone level. CONCLUSION The therapeutic effect of combined treatment is better than clomifene citrate alone in the treatment of PCOS.


RESUMO OBJETIVO Tendo em vista a alta incidência de síndrome dos ovários policísticos (SOP) e os efeitos terapêuticos insatisfatórios da dimetildiguanida ou do citrato de clomifeno isoladamente, nosso estudo teve como objetivo investigar os efeitos terapêuticos da dimetildiguanida associada ao citrato de clomifeno no tratamento da SOP. MÉTODOS Um total de 79 pacientes com POCS e 35 mulheres saudáveis foram incluídos, e biópsias endometriais foram obtidas. A expressão da proteína de ligação do elemento regulador de esterol-1 (SREBP1) nos tecidos endometriais foi detectada por qRT-PCR. Pacientes POC foram divididos aleatoriamente em grupo A (n=40) e grupo B (n=39). Os pacientes do grupo A foram tratados com dimetildiguanida combinada com citrato de clomifeno, enquanto os pacientes do grupo B foram tratados apenas com citrato de clomifeno. O número de folículos maduros e muco cervical, taxa de desenvolvimento folicular e taxa de ovulação, taxa de gravidez, abortamento precoce, taxa de ovulação, espessura endometrial, taxa positiva de três linhas, nível de hormônio folículo estimulante e nível de hormônio luteinizante foram comparados entre os dois grupos. RESULTADOS O nível de expressão do SREBP1 foi maior nos pacientes com SOP do que no controle normal. A expressão de SREBP1 foi inibida após o tratamento, enquanto os efeitos inibidores do tratamento combinado foram mais fortes do que os do citrato de clomifeno isoladamente. Comparado com o citrato de clomifeno sozinho, o tratamento combinado melhorou significativamente a pontuação do muco cervical, a taxa de desenvolvimento folicular, a taxa de ovulação do folículo único, a espessura endometrial, a taxa positiva de três linhas de sinal e o nível de hormônio folículo estimulante. CONCLUSÃO O efeito terapêutico do tratamento combinado é melhor do que o citrato de clomifeno isolado no tratamento da SOP.


Subject(s)
Humans , Female , Adult , Young Adult , Polycystic Ovary Syndrome/drug therapy , Clomiphene/therapeutic use , Fertility Agents, Female/therapeutic use , Hypoglycemic Agents/therapeutic use , Metformin/therapeutic use , Ovulation Induction , Cervix Mucus/drug effects , Gene Expression Regulation/drug effects , Clomiphene/pharmacology , Drug Therapy, Combination , Endometrium/physiopathology , Sterol Regulatory Element Binding Protein 1/adverse effects , Sterol Regulatory Element Binding Protein 1/genetics , Fertility Agents, Female/pharmacology , Ovarian Follicle/drug effects , Hypoglycemic Agents/pharmacology , Metformin/pharmacology
6.
Rev. Hosp. Ital. B. Aires (2004) ; 37(1): 10-20, mar. 2017. tab
Article in Spanish | LILACS | ID: biblio-966680

ABSTRACT

El síndrome de ovario poliquísticos (SOP) representa una de las endocrinopatías más frecuentes en la mujer y es la principal causa de hiperandrogenismo (HA). Se trata de un trastorno complejo, multifactorial, poligénico con influencias ambientales. Aunque se han propuestos diferentes criterios para su diagnóstico, se prefiere el uso del más abarcativo (Criterio de Rotterdam) con la presencia de 2 de 3 de los siguientes: 1) HA clínico o bioquímico, 2) oligoanovulación crónica (OA), 3) poliquistosis ovárica por ecografía, excluyendo otras etiologías. Es frecuente su asociación con comorbilidades metabólicas (obesidad, diabetes 2, dislipidemia, apnea del sueño, etc.) y trastornos reproductivos (hiperplasia endometrial e infertilidad), sobre todo en los fenotipos clásicos, con HA y OA. El tratamiento estará orientado a las características clínicas de cada paciente y al deseo reproductivo. La pérdida de peso en aquellas con sobrepeso u obesidad o ambos factores puede restaurar los ciclos menstruales y disminuir el riesgo metabólico y representa la primera línea de tratamiento. Los anticonceptivos orales (ACO) son el tratamiento farmacológico de elección ya que atenúan las manifestaciones de HA y ofrecen protección endometrial. En las pacientes con oligoanovulación que buscan embarazo, el citrato de clomifeno es el tratamiento aconsejado en primera instancia. La metformina podría usarse en aquellas con intolerancia a la glucosa o diabetes 2 y también como segunda línea de tratamiento para restaurar los ciclos e inducir la ovulación. (AU)


Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women, the main cause of hyperandrogenism (HA). It is a complex, multifactorial polygenic disorder with environmental influences. Although there have been proposed different criteria for diagnosis, using the most comprehensive (Criteria Rotterdam) with the presence of 2 of 3 of the following is preferred: 1) HA clinical or biochemical, 2) oligo-anovulation chronic (OA), 3) polycystic ovaries by ultrasound, excluding other etiologies. It is frequently associated with metabolic comorbidities (obesity, type 2 diabetes, dyslipidemia, sleep apnea, etc.) and reproductive disorders (endometrial hyperplasia and infertility), especially in the classical phenotypes, with HA and OA. The treatment will be oriented to the clinical characteristics of each patient and reproductive desire. Weight loss in those who are overweight and / or obesity can restore menstrual cycles and decrease metabolic risk and represents the first line of treatment. Oral contraceptives (OC) are the pharmacological treatment of choice as it attenuates the manifestations of HA and offer endometrial protection. In patients seeking pregnancy with oligo-anovulation, clomiphene citrate would be used at first instance. Metformin may be used in those with impaired glucose tolerance or type 2 diabetes and also as a second-line treatment to restore cycles and induce ovulation. (AU)


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Young Adult , Ovulation Induction/methods , Polycystic Ovary Syndrome/diagnosis , Hyperandrogenism/etiology , Anovulation/diagnosis , Polycystic Ovary Syndrome/physiopathology , Polycystic Ovary Syndrome/drug therapy , Polycystic Ovary Syndrome/therapy , Polycystic Ovary Syndrome/diagnostic imaging , Comorbidity , Puberty/metabolism , Clomiphene/therapeutic use , Contraceptives, Oral, Combined/therapeutic use , Endometrial Hyperplasia/diagnosis , Infertility, Female/diagnosis
7.
IJPR-Iranian Journal of Pharmaceutical Research. 2013; 12 (2): 475-481
in English | IMEMR | ID: emr-142670

ABSTRACT

PCOS [Polycystic Ovarian Syndrome] is associated with insulin resistance, obesity and disorders of lipid metabolism as well as infertility. Fenugreek seeds extract is successfully used in lowering blood glucose. Metformin has also the same effect but in a different way. The aim of this study was the assessment of fenugreek effects on insulin resistance in women with PCOS. This was a prospective randomized, double-blind, placebo-controlled trial. The study was conducted at the Montaserieh Hospital in Mashhad University of Medical Sciences, Mashhad, Khorasan Razavi Province, Iran. The patient population included 58 oligo-anovulatory PCOS women with typical ovaries. Women were randomly allocated to receive hydroalcoholic extract of fenugreek seeds in capsules with metformin [n = 30] or placebo capsules with metformin [n = 28] and were assessed before and every 4 weeks within a treatment period of 8 weeks. Menstrual disturbance and metabolic parameters [markers of insulin resistance and hormonal parameters] were measured. Insulin resistance based on HOMA-IR [homeostasis model assessment for insulin resistance] model was not significantly different between two groups. Ultrasound scans were performed before and at the end of 8 weeks treatment with significant decrease in PAO [polycystic appearing ovaries] in group 1 [p = 0/01]. Adjuvant therapy to the fenugreek seeds extract [with metformin] in PCOS women improved the sonographic results and menstrual cyclicity


Subject(s)
Humans , Female , Polycystic Ovary Syndrome/drug therapy , Insulin Resistance , Diabetes Mellitus, Type 2/drug therapy , Blood Glucose/drug effects , Plant Extracts , Phytotherapy/methods , Treatment Outcome , Prospective Studies , Double-Blind Method
8.
IJPM-International Journal of Preventive Medicine. 2013; 4 (10): 1169-1174
in English | IMEMR | ID: emr-148430

ABSTRACT

This study aims to evaluate the sex hormone binding globulin [SHBG] level as a predictor of response to pharmacological treatment in women with polycystic ovary syndrome [PCOS]. This study was conducted in 2009-2012 in Isfahan, Iran. Anovulatory women with a diagnosis of PCOS were studied. Metformin was started at 500 mg three times a day. If no ovulation occurred, Clomiphene citrate was added. The study comprised 273 infertile women with PCOS completed the study, 75 [28%] of them became pregnant 6 months after treatment [7.36% with metformin and 20.14% with metformin and clomiphene citrate]. Patients who responded to metformin treatment had significantly lower mean SHBG levels compared to those who did not [0.88+0.32vs. 0.2642+0.44 nmol/L, respectively, P<0.0001]. The area under the ROC curve [AUC] for prediction the response to treatment was 0.85. The baseline level of 27 was the most appropriate cut of point HSBG for the prediction of conception. HSBG had a sensitivity of 88%, and specificity of 73.6%. It had a false positive level of 26.4% and false negative level of 12%. Its positive predictive value was 56.4% and its negative predictive value was 94%. The chance of conception increased for reducing a unit of fpg [OR = 0.69; 95% CI = 0.54-0.86; P = .002], as well as reducing of every unit of HSBG [OR = 0.47; 95% CI = 0.39-0.56; P <0.001], and for reducing each unit of insulin in [OR = 0.082; 95% CI = 1.021-0.33; P <0.001]. HSBG test is suggested as an appropriate test for predicting pregnancy achievement of PCOs women after pharmacological treatment


Subject(s)
Humans , Female , Male , Polycystic Ovary Syndrome/drug therapy , Metformin , Clomiphene , Anovulation , Infertility, Female
9.
IJRM-Iranian Journal of Reproductive Medicine. 2012; 10 (3): 229-236
in English | IMEMR | ID: emr-144283

ABSTRACT

Polycystic ovary syndrome [PCOS] is a common cause of ovulatory disorders and infertility with high LH to FSH ratio. In order to prevent further increase of LH and follicle atresia, different regimens for ovulation induction have been recommended using FSH alone. This study was performed in PCOS patients to compare ART outcomes in cycles induced by FSH alone, using either recombinant or urinary products. In a randomized trial, from 623 patients who underwent down regulation with GnRH analogue in a long protocol, 160 PCOS patients were randomly divided into two groups of 80. Group A received 150 IU/d recombinant FSH [Gonal-F] and group B 150 IU/d urinary FSH [Fostimon]. 33 cases [41.2%] in group A and 36 [45%] in group B achieved clinical pregnancy, which was not significantly different [p=0.67]. Total number of oocytes retrieved [13.03 +/- 5.56 vs. 14.17 +/- 4.89, p=0.17], quality and number of embryos [7.42 +/- 3.35 vs. 7.63 +/- 3.28, p=0.68] and OHSS rate were similar in group A compared to group B. Endometrial thickness which was 9.66 +/- 1.67 mm in group A and 10.36 +/- 1.35 mm in group B, showed a significant difference [p=0.004]. It seems that in PCOS patients, both pure FSH products used for controlled ovarian hyperstimulation have similar effects on ART outcome and can be used according to availability and patient acceptance without significant difference


Subject(s)
Humans , Female , Young Adult , Adult , Follicle Stimulating Hormone/chemical synthesis , Follicle Stimulating Hormone , Polycystic Ovary Syndrome/drug therapy , Treatment Outcome , Randomized Controlled Trials as Topic , Prospective Studies , Pregnancy Rate
10.
Rev. Fac. Med. (Caracas) ; 34(1): 60-63, 2011. tab
Article in Spanish | LILACS | ID: lil-637406

ABSTRACT

El síndrome de ovario poliquístico es un desorden heterogéneo de etiología incierta, que cual afecta entre el 6% y 10% de las mujeres en edad reproductiva. Una de las opciones terapéuticas especificas es el uso de los anticonceptivos orales, con la progestina, drospirerona, la cual, es un análogo de la espironolactona que posee actividad antimineralcorticoides y antiandrogénica. El objetivo de este estudio fue determinar el efecto del anticonceptivo oral combinado (EE: 30 MG y DRP: 3 mg) en el perfil bioquímico y clínico en una población de mujeres venezolanas con síndrome de ovario poliquístico. De las 20 pacientes incluidas en el estudio, 18 completaron satisfactoriamente el estudio, con una buena tolerancia al tratamiento. Se observó una disminución del IMC de 23,94 en condición basal a 23,73 kg/m². Los niveles de andrógenos se encontraron disminuidos significativamente en comparación a la basal; testosterona total cayó de 1,4 ng/mL a 0,67 ng/mL; Testosterona libre bajo de 3 pg/mL a 1,38 pg/mL; DHEAS disminuyó de 1,65 µg/mL a 1,08 µg/mL y androstenediona de 2,50 ng/mL a 1,55 ng/mL. En conclusión nuestros resultados reportan que el uso de un anticonceptivo oral que contiene 30 mg de EE y 3 mg de progestina, drospirerona en una población de mujeres venezolanas con síndrome de ovario poliquístico condujo a una disminución de los niveles de andrógenos al mismo tiempo que se evidenció un incremento de la SHBG, así como una reducción no significativa del peso corporal de este grupo de pacientes y una mejoría clínica del hirsutismo.


Policystic ovarian syndrome is a heterogeneous disorder wich etiology remained uncertain and affects 6%-10% of reproductive age women. Most recommended therapy is oral contraceptives with progestins. Drospirenone is an espironolactone analogue exhibits a partial antiandrogenic action and has predominant anti-mineralocorticoid properties. This is a prospective trial to determine efficacy of a drospirenone-containing combined oral contraceptives in venezuelan women with polycystic ovary-syndrome. Twenty women were conducted into this trial, although 18 were treated. With treatment, BMI fell by 0,21 kg/m(2) in the study group. During therapy, the levels of testosterone, free testosterone, Delta (4)-androstenedione, and androstenedione decreased significantly, whereas sex hormone-binding globulin increased significantly. Treatment of women with polycystic ovary-syndrome with drospironene containing combined oral contraceptives formulations is effective in decreasing hirsutism, androgen levels and BMI.


Subject(s)
Adolescent , Adult , Contraceptives, Oral/therapeutic use , Ethinyl Estradiol/therapeutic use , Hyperandrogenism/pathology , Hyperandrogenism/drug therapy , Polycystic Ovary Syndrome/drug therapy , Polycystic Ovary Syndrome/therapy , Gynecology
11.
IJRM-Iranian Journal of Reproductive Medicine. 2011; 9 (1): 31-36
in English | IMEMR | ID: emr-109942

ABSTRACT

Polycystic ovary syndrome [PCOS] is associated with approximately 75% of women who suffer from infertility due to anovulation. Additionally, around 20-25% of anovulatory women with PCOS do not respond at all to clomiphene citrate and are considered to be "clomiphene-resistant". Aromatase inhibitors have been suggested as an alternative treatment to clomiphene as the discrepancy between ovulation and pregnancy rates with clomiphene citrate has been attributed to its anti-estrogenic action and estrogen receptor depletion. The aim of this study is to compare results of Metformin-letrozole with Metformin-clomiphene citrate in clomiphene resistance PCOS patients undergoing IUI. In this single blind randomized trial, ovarian cycles were studied in 100 clomiphene- resistant patients with PCOS. The inclusion criteria were patients who received 150mg clomiphene citrate daily for 3 cycles and failed to become pregnant. The patients were matched for their age, body mass index [BMI], and infertility period. They were randomly allocated to a metformin-letrozole group [n=50] and a metformin-clomiphene citrate group [n=50]. Chemical and clinical pregnancies were assessed after IUI. Abortion rates were determined in both groups. Regarding pregnancy rate, there was no significant difference between the two groups. One miscarriage [2%] occurred in the metformin-clomiphene citrate group, whereas none was seen in the metformin-letrozole group. There is no significant difference in pregnancy rate between clomiphene citrate and letrozole groups although it has been 2% in the former and 5% in the latter


Subject(s)
Humans , Female , Adult , Metformin , Clomiphene , Polycystic Ovary Syndrome/drug therapy , Drug Therapy, Combination , Treatment Outcome
13.
Rev. obstet. ginecol. Venezuela ; 70(4): 249-253, dic. 2010. ilus
Article in Spanish | LILACS | ID: lil-631432

ABSTRACT

Determinar el efecto de la terapia con metformina en pacientes infértiles con síndrome de ovarios poliquísticos. Estudio clínico, prospectivo y descriptivo. Incluyó pacientes con diagnóstico de síndrome de ovarios poliquísticos, infertilidad y resistencia a la insulina, a las que se les administró tratamiento con metformina por 3 meses. Las pacientes que no se embarazaron en ese período recibieron tratamiento con citrato de clomifeno, hasta un máximo de 6 meses. En el Servicio de Fertilidad Maternidad "Concepción Palacios". Caracas. Resultados: Se completó un total de 62 pacientes. La tasa de embarazo de 25,8 por ciento (19 pacientes). Un 57,9 por ciento de las pacientes lograron embarazo con 3 meses de tratamiento, con una P= 0,492 lo cual no fue estadísticamente significante. La tasa de embarazos con citrato de clomifeno fue de 23,5 por ciento (8 pacientes), P=0,684. El 63,2 por ciento (12) tuvo un embarazo a término. La tasa de aborto fue de 26,3 por ciento (5). La metformina induce ovulación espontánea en pacientes con síndrome de ovarios poliquísticos. No existe diferencia estadística entre la tasa de embarazos con la terapia con metformina sola y metformina con citrato de clomifeno. La metformina mejora la evolución de embarazo


To determine the effect of treatment with metformin in infertile patients with polycystic ovary syndrome. Clinical, prospective and descriptive study. Infertile anovulatory patients with polycystic ovary syndrome and insulin resistant were included, and all of them, were treated with metformin for 3 months. Patients who did not ovulate in this time, received clomiphene citrate for 6 months. Fertility Service of Maternidad "Concepcion Palacios". 62 infertile patients were included in this study. The pregnancy rate was 25.8 percent (19 patients). The 57.9 percent of women became pregnant with metformin administration for 3 months, with P= 0.492, it was not statistical significance. The pregnancy rate with clomiphene citrate was 23.5 percent (8 patients), P= 0.684. The abortion rate was 26.3 percent (5). The metformin induce ovulation in anovulatory polycystic ovary syndrome women, whereas the pregnancy rate resulted similar in both treatment groups: metformin alone and metformin and clomiphene citrate


Subject(s)
Humans , Female , Clomiphene/therapeutic use , Insulin Resistance , Infertility, Female/etiology , Infertility, Female/therapy , Metformin/therapeutic use , Polycystic Ovary Syndrome/diagnosis , Polycystic Ovary Syndrome/drug therapy , Polycystic Ovary Syndrome/therapy
15.
Tunisie Medicale [La]. 2010; 88 (5): 335-340
in French | IMEMR | ID: emr-108883

ABSTRACT

Polycystic ovarian syndrome [PCOS] is the most common hormonal dysfunction in women. It's a cause of female infertility by oligoanovulation, clinical and biochemical hyperandrogenism and polycystic ovaries. Weight loss, firstly proposed in overweight or obese patient suffering from PCOS, aims to reduce hyperinsulinism and hyperandrogenism. Recently, Metformin, an insulin sensitizer, has been proposed as an alternative first line treatment for polycystic ovarian syndrome by improving hyperinsulinemia and hyperandrogenism in these women. The aim of our study, and through a literature review, is to demonstrate if Metformin should be used as a first-line drug for infertile women with this syndrome or as an adjunction to Clomifene Citrate, the longest established treatment already used in this syndrome. A prospective comparative study including 63 patients with PCOS has been done during 2 years. Women were randomly allocated to clomifene + Metformin [Metformin group, Metformin took during 8 weeks, 850 mg twice a day, plus Clomifene 100 mg per day during five days] or Clomifene only [100 mg per day during five days]. All patients underwent a two- month's diet. The middle age was about 30.63 years and the body mass index [BMI] was about 29.88 kg/ m[2]. We noticed a 6.2% weight loss in both groups [a non significant difference in p=0.04]. The median of infertility period was about 2.49 years. The ovulation rate in the Metformin group was 53.12% [significant difference for inducing ovulation p=0.02] and 32.25% in Clomifene group [non-significant difference 0.07]. There was also a significant difference for ongoing pregnancies [p=0.04]. In fact, 11 on 32 patients [34%] achieved a full-term pregnancy in Metformin group versus only 4 ones on 31 patients [12.9%] in Clomifene group. Our conclusion is that Metformin is an effective addition to Clomifene Citrate in term of reestablishment of ovulation and full-term pregnancies achievement, excluding ART cycles


Subject(s)
Humans , Female , Polycystic Ovary Syndrome/drug therapy , Prospective Studies , Clomiphene , Ovulation Induction , Hyperandrogenism/drug therapy , Hyperinsulinism/drug therapy , Disease Management
16.
West Indian med. j ; 58(5): 433-436, Nov. 2009. tab
Article in English | LILACS | ID: lil-672516

ABSTRACT

BACKGROUND: This study was performed with the aim of evaluating the effect of metformin in reducing miscarriage when continued until the end of the first trimester of pregnancy in patients with polycystic ovary syndrome (pCOS) and infertility. SUBJECTS AND METHOD: From January 2004 to December 2005, a total of 75 pregnant women with PCOS were studied in three different groups. In Group A, metformin administration (500 mg three times daily (TDS)) was stopped immediately after diagnosis of pregnancy (5-6 weeks gestation), in Group B, metformin was administered until the end of 8 weeks gestation and in Group C until the end of 12 weeks gestation. The results of this study were then assessed using chi-square McNemar's, ANOVA Kruskal Wallis and logistic regression tests. RESULTS: There was a significant statistical difference between previous and current miscarriage in the current pregnancy with a decline in Group B from 40% to 8% and in group C from 32% to 4%. In spite of the reduced rate of miscarriage seen in Group A, from 20% to 4%, this difference was not statistically significant. Fetal anomalies were absent in all three groups. CONCLUSION: According to the current findings, it seems that continuing metformin during the first trimester of pregnancy has beneficial effects in patients with PCOS.


ANTECEDENTES: Este estudio fue realizado con el propósito de evaluar el efecto de la metmorfina en la reducción de abortos espontáneos cuando se la continúa hasta el final del primer trimestre de embarazo, en pacientes con síndrome de ovario poliquístico (SOPQ) e infertilidad. SUJETOS Y MÉTODO: De enero 2004 a diciembre 2005, fueron estudiadas en tres grupos diferentes, un total de 75 mujeres embarazadas que presentaban SOPQ. En el grupo A, la administración de metmorfina (TDS) 500 mg tres veces al día se detuvo inmediatamente después del diagnóstico del embarazo (5 - 6 semanas de gestación); en el grupo B, se administró la metmorfina hasta el final de las 8 semanas de gestación, y en el grupo C hasta el final de las 12 semanas de gestación. Los resultados de esta estudio fueron entonces evaluados usando chi-cuadrado McNemar's, ANOVA Kruskal Wallis y teste de regresión logística. RESULTADOS: Hubo una diferencia estadística significativa entre los abortos espontáneos previos y los corrientes en los embarazos corrientes, con una disminución del 40% al 8% en el grupo B, y del 32% al 4% en el Grupo C. A pesar de la reducción de la tasa de abortos espontáneos observada en el grupo A, del 20% al 4%, la diferencia no fue estadísticamente significativa. Las anomalías fetales estuvieron ausentes en los tres grupos. CONCLUSIÓN: De acuerdo con los hallazgos actuales, parece que la continuación de la metmorfina durante el primer trimestre del embarazo, tiene efectos beneficiosos en los pacientes con SOPQ.


Subject(s)
Adult , Female , Humans , Pregnancy , Young Adult , Abortion, Spontaneous/prevention & control , Hypoglycemic Agents/administration & dosage , Metformin/administration & dosage , Polycystic Ovary Syndrome/drug therapy , Drug Administration Schedule , Pregnancy Trimester, First , Polycystic Ovary Syndrome/complications
17.
Femina ; 37(11)nov. 2009. ilus, tab
Article in Portuguese | LILACS, SES-SP | ID: lil-545658

ABSTRACT

A maior parte dos trabalhos, assim como diversas revisões sistemáticas, éfavorável à utilização da metformina no tratamento da síndrome dos ovários policísticos. No entanto, as revisõessistemáticas sobre o tema quase sempre têm pouco poder estatístico e grande heterogeneidade, o que as tornainconclusivas. Será improvável conter a disseminação da utilização empírica da medicação no tratamento destaendocrinopatia. É preciso ter cautela, sobretudo na utilização desta droga durante a gravidez ou em tempoprolongado para evitar as possíveis complicações tardias da SOP, até que novas revisões sistemáticas baseadas emtrabalhos randomizados bem desenhados e com grande número de participantes sejam realizados, principalmenteestudos multicêntricos, para aumentar o poder estatístico e evitar a heterogeneidade. A mudança de estilo devida é a primeira alternativa terapêutica para a síndrome dos ovários policísticos em mulheres com excesso depeso ou aumento de gordura viscera


The majority of scientific papers, as well as several systematic revisions, arefavorable to the use of metformin for the treatment of ovary polycystic syndrome. However, specific systematicrevisions have little statistical power and great heterogeneity, which makes them inconclusive. It is unlikely tocontrol the empiric use of metformin for treating this endocrinopathy. Its necessary to have caution with regardto the use of this medication, especially during pregnancy or at long term, in order to prevent late complicationsof the syndrome, till new systematic revisions from randomized and well designed studies with significant numberof patients be done, mainly multicentre studies that may increase the statistic power and avoid heterogeneity.The change in lifestyle is the first therapeutic option for the treatment of polycystic ovary syndrome in womenwho present obesity and excess of visceral fat.


Subject(s)
Female , Life Style , Pregnancy , Hyperandrogenism , Evidence-Based Medicine , Metformin/adverse effects , Metformin/therapeutic use , Polycystic Ovary Syndrome/drug therapy , Diet Therapy , Exercise/physiology
18.
Femina ; 37(6): 339-345, jun. 2009. tab
Article in Portuguese | LILACS | ID: lil-534080

ABSTRACT

A segunda parte desta revisão inclui as demais opções de tratamento da síndrome do ovário policístico (SOP). O citrato de clomifeno (CC) é utilizado na dose de 50 a 200 mg/dia durante cinco dias a partir do segundo ao quinto dia do ciclo menstrual. A taxa de ovulação após o tratamento com CC é de aproximadamente 73 por cento e a de gravidez em torno de 36 por cento. Com os análogos do GnRH ocorre redução dos níveis de gonadotrofinas e diminuição da secreção de estrógenos e androgênios. O principal risco da estimulação com gonadotrofinas é a gestação múltipla. Anastrazole e letrozole pertencem à classe dos inibidores da aromatase de terceira geração. As taxas de ovulação e gestação com letrozole variam de 54,5 a 82,4 por cento e 9 a 25 por cento, respectivamente. Não ocorreu diferença significativa nas taxas de ovulação e gestação entre o uso de 2,5 mg de letrozole em comparação com 1 mg de anatrozole. O uso da N-acetilcisteína (NAC) sugere melhora significativa da sensibilidade à insulina em mulheres com SOP. Os contraceptivos hormonais orais combinados permanecem como tratamento predominante para redução do hiperandrogenismo e das irregularidades menstruais em mulheres que não desejam engravidar. Os antiandrógenos são utilizados principalmente para diminuir as queixas de hirsutismo e o efeito será percebido em 9 a 12 meses de tratamento. Muitas mulheres se submetem à cauterização ovariana ou a laser por videolaparoscopia tendo restauração espontânea da ovulação com gravidez subsequente. Porém, os benefícios potenciais destas intervenções tendem a ser atenuados devido à formação de aderências.


The second part of this review includes other treatment options for polycystic ovary syndrome (PCOS). The clomiphene citrate (CC) is used in a dose of 50 to 200 mg/day for five days, begining from the second to fifth day or the menstrual cycle. The ovulation rate after the treatment with CC is approximately 73 percent and the pregnancy rate is about 36 percent. With GnRH analogues, there is a reduction in gonadotrophin levels and a decrease of androgen and estrogen secretion. The major risk due to stimulation with gonadotrophins is the multiple gestation. Anastrozole and letrozole belong to the class of third-generation aromatase inhibitors. The rates of ovulation and pregnancy with letrozole vary from 54.5 to 82.4 percent and from 9 to 25 percent, respectively. There was no significant difference in ovulation and pregnancy rates with the use of 2.5 mg of letrozole compared to 1 mg of anastrozole. The use of N-acetyl Cysteine (NAC) suggests significant improvement in insulin sensibility in women with PCOS. The combined oral hormonal contraceptives are still the predominant treatment to decrease hyperandrogenism and menstrual irregularities in women who do not want to get pregnant. Anti-androgens are used mainly to diminish complaints of hirsutism and the effect will be noted after 9 to 12 months of treatment. Several women undergo ovarian cauterization of with laser by videolaparoscopy having their ovulation spontaneously restored with subsequent pregnancy. However, the potential benefits of these interventions might be attenuated due to adhesion formations.


Subject(s)
Female , Contraceptives, Oral, Hormonal/therapeutic use , Clomiphene/therapeutic use , Gonadotropins/therapeutic use , Hyperandrogenism/metabolism , Gonadotropin-Releasing Hormone/analogs & derivatives , Laparoscopy/methods , Polycystic Ovary Syndrome/drug therapy , Polycystic Ovary Syndrome/therapy , Infertility/drug therapy , Review Literature as Topic
20.
Femina ; 37(5): 255-260, maio 2009.
Article in Portuguese | LILACS | ID: lil-539342

ABSTRACT

A síndrome dos ovários policísticos (SOP) é uma das mais comuns endocrinopatias que acometem mulheres em idade reprodutiva, com prevalência de 4 a 12 % em diferentes populações. Mudança nos hábitos de vida são estratégias iniciais no tratamento de mulheres obesas com SOP, melhorando sensibilidade à insulina, hiperandrogenismo, fatores de riscos metabólicos, ciclos menstruais e ovulação, e reduzindo tanto o número de folículos ovarianos retidos como o volume ovariano, regulando a fertilidade e a capacidade reprodutiva. Uma dieta pobre em gorduras saturadas e rica em fibras, com alimentos de baixo índice glicêmico de carboidratos, é geralmente adequada para mulheres com SOP. Os agentes sensibilizadores da insulina também fazem parte do manejo dessas pacientes. Avaliação do uso de metformina e citrato de clomifeno mostrou que as taxas de ovulação foram efetivas tanto com o uso isolado da metformina quanto em associação ao citrato de clomifeno, porém, quanto ao número de gestações, foi obtido melhor resultado com a associação de ambos os medicamentos. As glitazonas também têm sido utilizadas nas desordens metabólicas na SOP. A administração de rosiglitazona 4 mg/dia ou de pioglitazona 30 mg/dia a mulheres obesas e não obesas com SOP levou a uma melhoria da resistência a insulina, diminuição da produção androgênica ovariana, restauração da ovulação espontânea.


Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases affecting women in reproductive age with prevalence estimated at 4 a 12 % in different populations. Lifestyle changes are the first strategy for the treatment of obese women with PCOS, improving insulin sensitivity, hyperandrogenaemia, metabolic risk factors, menstrual cycles and ovulation, reducing the number of un-ruptured follicles, the ovarian volume, regulating fertility and reproduction capacity. A low-liped diet, rich in fibers and with food of low carbohydrate rate is usually adequate for women with PCOS. Insulin-sensitizing agents also play a role on the management of these patients. Evaluation of the use of metformin and citrate of clomiphen demonstrated that ovulatin were effective not only with metformin alone, but also in association with citrate of clomiphene; however, concerning the number of pregnancies, better results were achieved in the association of both drugs. Glitazones have been also used in metabolic disorders of PCOS. The administration of rosigliatazone 4 mg/day or pioglitazone 30 mg/day in obese and non-obese women led to an improvement in insulin resistance, reduction of ovarian androgen production and recuperation of spontaneous ovulation.


Subject(s)
Female , Insulin Resistance , Metformin/therapeutic use , Overweight , Obesity/drug therapy , Obesity/therapy , Polycystic Ovary Syndrome/metabolism , Polycystic Ovary Syndrome/drug therapy , Polycystic Ovary Syndrome/therapy , Thiazolidinediones/therapeutic use , Exercise , Life Style
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