Comprehensive Management of Polycystic Ovary Syndrome: The Role of Metformin in Addressing Metabolic and Endocrine Dysregulation
DOI:
https://doi.org/10.12775/JEHS.2025.77.56421Keywords
Polycystic Ovary Syndrome (PCOS), insulin resistance, hyperandrogenism, Rotterdam criteria, metformin, lifestyle interventionsAbstract
Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine and metabolic disorder that affects women of reproductive age, characterized by hormonal imbalances, insulin resistance, and a range of clinical manifestations, including infertility and metabolic disturbances. Effective management of PCOS remains a challenge due to its multifaceted nature, necessitating a comprehensive understanding of therapeutic options.
Aim of the Study: This paper aims to explore the role of various treatment modalities for PCOS, with a particular emphasis on the use of metformin, an antidiabetic medication increasingly recognized for its benefits in managing insulin resistance and other associated conditions in PCOS patients.
Conclusion: The findings highlight metformin's three primary mechanisms of action: enhancing insulin sensitivity, inhibiting hepatic gluconeogenesis, and influencing lipid metabolism. Metformin is effective in improving metabolic parameters and restoring ovulatory function in women with PCOS. While it is a cornerstone of therapy, the management of PCOS requires a tailored approach that considers individual clinical symptoms and phenotypes. Additional therapeutic strategies, including non-pharmacological measures and other pharmacological agents, play a vital role in a comprehensive treatment plan for PCOS.
References
Siddiqui S, Mateen S, Ahmad R, Moin S. A brief insight into the etiology, genetics, and immunology of polycystic ovarian syndrome (PCOS). J Assist Reprod Genet. listopad 2022;39(11):2439–73.
2. Collée J, Mawet M, Tebache L, Nisolle M, Brichant G. Polycystic ovarian syndrome and infertility: overview and insights of the putative treatments. Gynecol Endocrinol. 3 październik 2021;37(10):869–74.
3. The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 1 styczeń 2004;19(1):41–7.
4. Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. grudzień 2016;31(12):2841–55.
5. Stener-Victorin E, Padmanabhan V, Walters KA, Campbell RE, Benrick A, Giacobini P, i in. Animal Models to Understand the Etiology and Pathophysiology of Polycystic Ovary Syndrome. Endocr Rev. 1 sierpień 2020;41(4):bnaa010.
6. Yuwen T, Yang Z, Cai G, Feng G, Liu Q, Fu H. Association between serum AMH levels and IVF/ICSI outcomes in patients with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol. 23 październik 2023;21(1):95.
7. Bednarska S, Siejka A. The pathogenesis and treatment of polycystic ovary syndrome: What’s new? Adv Clin Exp Med. 27 kwiecień 2017;26(2):359–67.
8. Sharma A, Welt CK. Practical Approach to Hyperandrogenism in Women. Med Clin North Am. listopad 2021;105(6):1099–116.
9. Kiddy DS, Hamilton‐Fairley D, Bush A, Short F, Anyaoku V, Reed MJ, i in. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf). styczeń 1992;36(1):105–11.
10. Moran LJ, Ranasinha S, Zoungas S, McNaughton SA, Brown WJ, Teede HJ. The contribution of diet, physical activity and sedentary behaviour to body mass index in women with and without polycystic ovary syndrome. Hum Reprod. sierpień 2013;28(8):2276–83.
11. Shahid R, Iahtisham‐Ul‐Haq, Mahnoor, Awan KA, Iqbal MJ, Munir H, i in. Diet and lifestyle modifications for effective management of polycystic ovarian syndrome (PCOS). J Food Biochem [Internet]. lipiec 2022 [cytowane 17 grudzień 2024];46(7). Dostępne na: https://onlinelibrary.wiley.com/doi/10.1111/jfbc.14117
12. Escobar-Morreale HF, Santacruz E, Luque-Ramírez M, Botella Carretero JI. Prevalence of ‘obesity-associated gonadal dysfunction’ in severely obese men and women and its resolution after bariatric surgery: a systematic review and meta-analysis. Hum Reprod Update. 1 lipiec 2017;23(4):390–408.
13. Han Y, Hou Y, Han Q, Yuan X, Chen L. Dietary supplements in polycystic ovary syndrome–current evidence. Front Endocrinol. 27 wrzesień 2024;15:1456571.
14. Arentz S, Smith CA, Abbott J, Bensoussan A. Nutritional supplements and herbal medicines for women with polycystic ovary syndrome; a systematic review and meta-analysis. BMC Complement Altern Med. grudzień 2017;17(1):500.
15. Forslund M, Melin J, Alesi S, Piltonen T, Romualdi D, Tay CT, i in. Combined oral contraceptive pill compared with no medical treatment in the management of polycystic ovary syndrome: A systematic review. Clin Endocrinol (Oxf). lipiec 2023;99(1):79–91.
16. Melin J, Forslund M, Alesi S, Piltonen T, Romualdi D, Spritzer PM, i in. Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab. 18 styczeń 2024;109(2):e817–36.
17. Pkhaladze L, Russo M, Unfer V, Nordio M, Basciani S, Khomasuridze A. Treatment of lean PCOS teenagers: a follow-up comparison between Myo-Inositol and oral contraceptives. Eur Rev Med Pharmacol Sci. grudzień 2021;25(23):7476–85.
18. Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler J. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocr Connect. listopad 2017;6(8):647–58.
19. Spritzer PM, Lisboa KO, Mattiello S, Lhullier F. Spironolactone as a single agent for long‐term therapy of hirsute patients. Clin Endocrinol (Oxf). 19 maj 2000;52(5):587–94.
20. Zeng H, Zhang Y, Huang S, Wu J, Ren W, Zhou L, i in. Metformin combined with spironolactone vs. metformin alone in polycystic ovary syndrome: a meta-analysis. Front Endocrinol. 10 sierpień 2023;14:1223768.
21. Motta A. Mechanisms Involved in Metformin Action in the Treatment of Polycystic Ovary Syndrome. Curr Pharm Des. 1 wrzesień 2009;15(26):3074–7.
22. American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2020. Diabetes Care. 1 styczeń 2020;43(Supplement_1):S98–110.
23. LaMoia TE, Shulman GI. Cellular and Molecular Mechanisms of Metformin Action. Endocr Rev. 28 styczeń 2021;42(1):77–96.
24. Herman R, Kravos NA, Jensterle M, Janež A, Dolžan V. Metformin and Insulin Resistance: A Review of the Underlying Mechanisms behind Changes in GLUT4-Mediated Glucose Transport. Int J Mol Sci. 23 styczeń 2022;23(3):1264.
25. Giannarelli R, Aragona M, Coppelli A, Del Prato S. Reducing insulin resistance with metformin: the evidence today. Diabetes Metab. wrzesień 2003;29(4):6S28–35.
26. Carvajal R, Rosas C, Kohan K, Gabler F, Vantman D, Romero C, i in. Metformin augments the levels of molecules that regulate the expression of the insulin-dependent glucose transporter GLUT4 in the endometria of hyperinsulinemic PCOS patients. Hum Reprod. 1 sierpień 2013;28(8):2235–44.
27. Moore MC, Coate KC, Winnick JJ, An Z, Cherrington AD. Regulation of Hepatic Glucose Uptake and Storage In Vivo. Adv Nutr. maj 2012;3(3):286–94.
28. Petersen MC, Vatner DF, Shulman GI. Regulation of hepatic glucose metabolism in health and disease. Nat Rev Endocrinol. październik 2017;13(10):572–87.
29. Zhou G, Myers R, Li Y, Chen Y, Shen X, Fenyk-Melody J, i in. Role of AMP-activated protein kinase in mechanism of metformin action. J Clin Invest. 15 październik 2001;108(8):1167–74.
30. Pernicova I, Korbonits M. Metformin—mode of action and clinical implications for diabetes and cancer. Nat Rev Endocrinol. marzec 2014;10(3):143–56.
31. DeFronzo R, Fleming GA, Chen K, Bicsak TA. Metformin-associated lactic acidosis: Current perspectives on causes and risk. Metabolism. luty 2016;65(2):20–9.
32. Emslie‐Smith AM, Boyle DIR, Evans JMM, Sullivan F, Morris AD, for the DARTS/MEMO Collaboration. Contraindications to metformin therapy in patients with Type 2 diabetes—a population‐based study of adherence to prescribing guidelines. Diabet Med. czerwiec 2001;18(6):483–8.
33. Arroyo AM, Walroth TA, Mowry JB, Kao LW. The MALAdy of Metformin Poisoning: Is CVVH the Cure? Am J Ther. styczeń 2010;17(1):96–100.
34. Keller G, Cour M, Hernu R, Illinger J, Robert D, Argaud L. Management of Metformin-Associated Lactic Acidosis by Continuous Renal Replacement Therapy. Gold JA, redaktor. PLoS ONE. 11 sierpień 2011;6(8):e23200.
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Copyright (c) 2025 Martyna Kaźmierczak, Jakub Parys, Agnieszka Mikosińska, Patrycja Kałuziak, Marta Jajaczak, Maciej Mossakowski, Aleksandra Witek, Mateusz Litwin, Stanisław Jesionek
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