Randomized clinical trial evaluating metformin versus oral contraceptive pills in the treatment of adolescents with polycystic ovarian syndrome
Abstract
BACKGROUND: Polycystic ovarian syndrome (PCOS) is characterized by irregular menses, elevated androgens, and insulin resistance. Little information is published about the treatment of adolescent PCOS. OBJECTIVES: The aim of this study was to evaluate metformin versus oral contraceptive pills (OCP) in treating adolescent PCOS. Twenty-two girls were randomized to either treatment for 6 months. The outcomes variables included body mass index (BMI) and free testosterone (FT). RESULTS: BMI decreased in all patients (metformin p=0.004, OCP p=0.045). FT decreased significantly only with OCP. Insulin resistance measures decreased in all patients but did not reach significance. The only significant difference in any of the variables between the two groups was number of menses. BMI and FT remained less than baseline for 3 months off treatment. CONCLUSIONS: Metformin and OCP have a positive effect on BMI, which persists after treatment is discontinued. FT decreased with both treatments, but only reached significance with OCP.
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In women with PCOS, there is no difference in health-related quality of life between the compared treatments.
“Results from 3 identified studies (32, 42, 50) showed conflicting results and our overall assessment is that there is no difference in quality of life.”
From Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis (2024) · cites this paper as [42]
Metformin at a dose of 1700 to 2000 mg/d is associated with greater improvement of BMI according to a meta-analysis of metformin vs oral contraceptives in adolescents with PCOS and including four RCTs (170 adolescents).
“Metformin at a dose of 1700 to 2000 mg/d is associated with greater improvement of BMI, and COCPs are associated with improvement in menstrual irregularity and acne according to a meta-analysis of metformin vs oral contraceptives in adolescents with PCOS and including four RCTs (170 adolescents) [164, 180–184].”
From Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls (2019) · cites this paper as [182]
Multiple observational studies and six RCTs evaluating the effect of metformin on a total of 275 adolescents with PCOS have demonstrated short-term beneficial effects mostly in adolescents with overweight/obesity.
“There have been multiple observational studies and six RCTs evaluating the effect of metformin on a total of 275 adolescents with PCOS. These studies have demonstrated short-term beneficial effects mostly in adolescents with overweight/obesity [164, 180–183].”
From Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls (2019) · cites this paper as [182]
COCPs improve menstrual irregularity in adolescents with PCOS.
“COCPs improve menstrual irregularity in adolescents with PCOS [164, 180–184].”
From Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls (2019) · cites this paper as [182]
COCPs are associated with improvement in menstrual irregularity and acne according to a meta-analysis of metformin vs oral contraceptives in adolescents with PCOS.
“Metformin at a dose of 1700 to 2000 mg/d is associated with greater improvement of BMI, and COCPs are associated with improvement in menstrual irregularity and acne according to a meta-analysis of metformin vs oral contraceptives in adolescents with PCOS and including four RCTs (170 adolescents) [164, 180–184].”
From Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls (2019) · cites this paper as [182]
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- Authors
- Al-Zubeidi, H., & Klein, K. O.
- Affiliations
- University of Tennessee Health Science Center (US)
- University of California San Diego (US)
- Corresponding author
- Klein, Karen O.
- ORCID
- Klein, Karen O.
- Venue
- Journal of Pediatric Endocrinology and Metabolism
- Publisher
- Walter de Gruyter GmbH
- Published
- 2015-01-01
- Volume
- 28
- Issue
- 7-8
- Pages
- 853-8
- ISSN
- 0334-018X (ISSN-L)
- 2191-0251
- OpenAlex
- W349248690
- Cited by
- 24
- References
- 18
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 2 · 2017: 4 · 2016: 4
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Pediatric Endocrinology and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- polycystic ovary syndrome, adolescents, metformin, oral contraceptives, insulin resistance, body mass index, free testosterone, menstrual irregularity, hyperandrogenism
- MeSH terms
- Adolescent, Androgens, Child, Chromatography, Liquid, Contraceptives, Oral, Combined, Female, Follow-Up Studies, Humans, Hypoglycemic Agents, Insulin Resistance, Menstruation Disturbances, Metformin, Polycystic Ovary Syndrome, Testosterone, Body Mass Index, Tandem Mass Spectrometry
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