Hum. Reprod. Advance Access published online on January 29, 2007
Human Reproduction, doi:10.1093/humrep/dem005
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
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
This paper is based on a Cochrane review to be published in The Cochrane Library, 24 January 2007 (see www.thecochranelibrary.com for information) with permission from The Cochrane Collaboration and John Wiley & Sons. Cochrane reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of review authors and are not necessarily shared by The Cochrane Collaboration.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S.M. Carlsen, E. Vanky, and R. Fleming Anti-Mullerian hormone concentrations in androgen-suppressed women with polycystic ovary syndrome Hum. Reprod., July 1, 2009; 24(7): 1732 - 1738. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Swingler, A. Awala, and U. Gordon Hirsutism in young women Obstet Gynaecol (Lond), April 1, 2009; 11(2): 101 - 107. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Palomba, A. Falbo, F. Zullo, and F. Orio Jr. Evidence-Based and Potential Benefits of Metformin in the Polycystic Ovary Syndrome: A Comprehensive Review Endocr. Rev., February 1, 2009; 30(1): 1 - 50. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Jensterle, A. Janez, B. Mlinar, J. Marc, J. Prezelj, and M. Pfeifer Impact of metformin and rosiglitazone treatment on glucose transporter 4 mRNA expression in women with polycystic ovary syndrome. Eur. J. Endocrinol., June 1, 2008; 158(6): 793 - 801. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Cosma, B. A. Swiglo, D. N. Flynn, D. M. Kurtz, M. L. LaBella, R. J. Mullan, M. B. Elamin, P. J. Erwin, and V. M. Montori Insulin Sensitizers for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1135 - 1142. [Abstract] [Full Text] [PDF]
|
|