Improved Efficacy of Low-Dose Spironolactone and Metformin Combination Than Either Drug Alone in the Management of Women With Polycystic Ovary Syndrome: A Six-Month, Open-Label Randomized Study

July 2013 in “ The Journal of Clinical Endocrinology and Metabolism ”

Mohd Ashraf Ganie, Madan Lal Khurana, Shazia Nisar, Parvaiz Ahmed Shah, Zaffar Amin Shah, Bindu Kulshrestha, Nidhi Gupta, Mohammad Afzal Zargar, Tariq Ahmed Wani, Syed Mudasir Ahmad, Majid Farooq, Shahnaz Taing

spironolactone metformin Polycystic Ovary Syndrome PCOS hirsutism Ferriman-Gallwey score serum total testosterone insulin sensitivity Aldactone Glucophage

From the encyclopedia

Spironolactone →

powerful topical and oral anti-androgen used mostly by women

Metformin →

diabetes drug with anti-inflammatory, immunomodulatory, and insulin-sensitizing properties

Studysummary This study found that combining low-dose spironolactone with metformin provided greater clinical benefits and improved treatment compliance in women with PCOS compared to either drug alone. Our plain-language summary of this paper — not a Tressless recommendation.

In the September 2013 study, researchers found that a combination of low-dose spironolactone (50 mg/day) and metformin (1000 mg/day) was more effective than either drug alone in managing symptoms of Polycystic Ovary Syndrome (PCOS) in women. The six-month study included 198 women, with 169 completing the study. The combination therapy led to significant improvements in menstrual cycles, hirsutism (as measured by the Ferriman-Gallwey score), serum total testosterone levels, and insulin sensitivity without significant changes in body weight, BMI, waist-hip ratio, or blood pressure. The combination group also experienced better compliance and fewer adverse events. The study concluded that the combination of spironolactone and metformin offers superior clinical benefits for women with PCOS compared to monotherapy with either drug.

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Research cited in this study

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research Influence of Spironolactone Treatment on Endothelial Function in Non-Obese Women with Polycystic Ovary Syndrome

50 citations , March 2011 in “European Journal of Endocrinology”

This study found that spironolactone treatment can normalize endothelial function and improve cholesterol levels in non-obese patients with polycystic ovary syndrome.

research Polycystic Ovary Syndrome: Etiology, Pathogenesis, and Diagnosis

991 citations , January 2011 in “Nature Reviews Endocrinology”

This paper reviews the diagnostic criteria, associated morbidities, and possible evolutionary advantages of polycystic ovary syndrome, but does not report any new findings.

Polycystic Ovary Syndrome: A Complex Condition with Psychological, Reproductive, and Metabolic Manifestations That Impacts Health Across the Lifespan

research Polycystic Ovary Syndrome: A Complex Condition with Psychological, Reproductive, and Metabolic Manifestations That Impacts Health Across the Lifespan

926 citations , June 2010 in “BMC Medicine”

This review emphasizes the need for comprehensive guidelines to address the cardiometabolic and psychological features of polycystic ovary syndrome, alongside its reproductive aspects, and reports no new results.

Metformin: An Old Medication of New Fashion: Evolving New Molecular Mechanisms and Clinical Implications in Polycystic Ovary Syndrome

research Metformin: An Old Medication of New Fashion: Evolving New Molecular Mechanisms and Clinical Implications in Polycystic Ovary Syndrome

200 citations , October 2009 in “European journal of endocrinology”

This review discusses the multifaceted actions of metformin in polycystic ovary syndrome and reports no new clinical results; the authors emphasize metformin's potential benefits in both cardiometabolic and reproductive aspects of PCOS.

research Spironolactone Versus Placebo or in Combination with Steroids for Hirsutism and/or Acne

112 citations , April 2009 in “Cochrane library”

This review found some evidence suggesting that spironolactone can effectively reduce hirsutism in women but did not support its use for treating acne vulgaris.

research Evidence-Based and Potential Benefits of Metformin in Polycystic Ovary Syndrome: A Comprehensive Review

343 citations , December 2008 in “Endocrine Reviews”

This review discusses the various evidence-based and potential applications of metformin in treating and preventing symptoms and complications associated with polycystic ovary syndrome but reports no new clinical results.

Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline

research Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline

1744 citations , August 2006 in “The Journal of Clinical Endocrinology and Metabolism”

This review discusses definitions of polycystic ovary syndrome and reports no new clinical results; the authors support using modified 1990 NIH criteria and acknowledge ongoing evolution as research advances.

research A Comparison Between Spironolactone and Spironolactone Plus Finasteride in the Treatment of Hirsutism

47 citations , March 2004 in “European journal of endocrinology”

This study found that the combination of spironolactone and finasteride significantly improved hirsutism scores more than spironolactone alone in women, with similar side-effect profiles between treatments.

Comparison of Spironolactone, Flutamide, and Finasteride Efficacy in the Treatment of Hirsutism: A Randomized, Double-Blind, Placebo-Controlled Trial

research Comparison of Spironolactone, Flutamide, and Finasteride Efficacy in the Treatment of Hirsutism: A Randomized, Double-Blind, Placebo-Controlled Trial

94 citations , January 2000 in “The Journal of Clinical Endocrinology and Metabolism”

This study found that spironolactone, flutamide, and finasteride are similarly effective in reducing hair diameter and Ferriman-Gallwey scores in women with hirsutism over a 6-month treatment period.

research The Effects of Two Doses of Spironolactone on Serum Androgens and Anagen Hair in Hirsute Women

142 citations , February 1985 in “Fertility and sterility”

This study found that spironolactone reduced serum androstenedione and anagen hair shaft diameter in hirsute patients but did not significantly alter unbound testosterone levels, suggesting its effects are primarily peripheral.