Metformin as a New Therapeutic Option for Endometriosis: Promise, Limits and Future Directions

Abstract

Endometriosis is a chronic, estrogent-dependent, inflammatory disease affecting a plethora of women of reproductive age and is a major cause of pelvis pain and subfertility. Current treatments – surgery and hormonal supression are often only partly effective, lead to further fertility issues or have substantial adverse effects, creating an unmet need for a non-hormonal, disease modyfing therapy option (Carvalho, J. C., et al; 2021). Metformin, a biguanide used worldwide as a first-line insulin-sensitizing drug for type 2 diabetes, has emerged as a therapeutic option for endometriosis because of its pleiotropic anti-inflammatory, anti-proliferative, anti-angiogenic and metabolic effects. This paper analyses mechanistic, preclinical and early clinical evidence on metformin use in endometriosis, with particular attention to how the drug interacts with the known pathophysiology of the disease (Kimber-Trojnar, Ż., et al; 2022). Rather than an immediate replacement for standard hormonal therapies, metformin currently appears best positioned as a promising adjuvant or alternative for selected patients – particularly those with co-existing metabolic dysfunction pending high-quality clinical trials (Zhang, H., et al; 2023).