Hum. Reprod. Advance Access originally published online on January 29, 2007
Human Reproduction 2007 22(5):1200-1209; doi:10.1093/humrep/dem005
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Metformin versus oral contraceptive pill in polycystic ovary syndrome: a Cochrane review
1 Division of Obstetrics and Gynaecology, School of Women's and Children's Health, University of New South Wales, Royal Hospital for Women, Sydney, NSW, 2031, Australia 2 Department of Reproductive Medicine, Royal Hospital for Women, Sydney, NSW, Australia 3 IVFAustralia, Sydney, NSW, Australia 4 National Women's Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand 5 Fertility Centre Scandinavia, Stockholm Storangsvagen 10, Stockholm, Sweden
6 To whom correspondence should be addressed at: Division of Obstetrics and Gynaecology, School of Women's and Children's Health, Level 1 Women's Health Institute, Royal Hospital for Women, Locked Bag 2000, Randwick, Sydney, NSW 2031, Australia. Fax: 61 2 9382 6444; E-mail: mfcostello{at}unsw.edu.au
BACKGROUND: The object of this review was to compare metformin versus oral contraceptive pill (OCP) treatment in polycystic ovary syndrome.
METHODS: A systematic review and meta-analysis employing the principles of the Cochrane Menstrual Disorders and Subfertility Group was undertaken.
RESULTS: Four randomized controlled trials (RCTs) (104 subjects) were included. Limited data demonstrated no evidence of a difference in effect between metformin and the OCP on hirsutism, acne or development of type 2 diabetes mellitus. There were no trials assessing diagnosis of cardiovascular disease or endometrial cancer. Metformin, in comparison with the OCP, was less effective in improving menstrual pattern [Peto odds ratio (OR) 0.08, 95% confidence interval (CI) 0.01–0.45) and in reducing the serum total testosterone level weighted mean difference (WMD) 0.54, 95% CI 0.22–0.86] but more effective in reducing fasting insulin (WMD –3.46, 95% CI – 5.39 to –1.52) and not increasing fasting triglyceride (WMD –0.48, 95% CI – 0.86 to –0.09) levels. Limited data demonstrated no evidence of a difference in effect between the two therapies on reducing fasting glucose or total cholesterol levels and severe adverse events.
CONCLUSIONS: The limited RCT evidence to date does not show adverse metabolic risk with the use of the OCP compared with metformin. Further long-term RCTs are required.
Key words: meta-analysis/metformin/oral contraceptive pill/polycystic ovary syndrome
Submitted on November 29, 2006; accepted on January 3, 2007.
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