Metformin or thiazolidinedione therapy in PCOS?

    February 2011 in “Nature Reviews Endocrinology
    Anjali Grover, Maria A. Yialamas
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    TLDR Metformin and thiazolidinediones are similarly effective for PCOS, but metformin is often preferred due to fewer side effects.
    The document reviewed the effectiveness of metformin and thiazolidinediones in treating polycystic ovary syndrome (PCOS), focusing on insulin resistance. A meta-analysis of 10 randomized clinical trials showed no overall superiority between the drug classes. Thiazolidinediones were better at reducing free testosterone and DHEAS at 3 months, but not at 6 months, while metformin was more effective in lowering triglyceride levels and BMI after 6 months. There were no significant differences in ovulation, pregnancy rates, insulin sensitivity, or other lipid levels. Metformin is generally preferred due to fewer adverse effects, although it can cause gastrointestinal issues and rare lactic acidosis. Thiazolidinediones have been linked to cardiovascular risks, weight gain, liver toxicity, and potential fetal harm. Treatment choice should be personalized, with metformin being a good option for obese patients seeking fertility treatment, considering individual therapeutic goals and side effect profiles.
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