|
|
|
|
|
|
Polycystic Ovarian Syndrome (PCOS) is a very common reproductive disorder. Women with PCOS frequently have irregular menstrual cycles, excessive body hair, are overweight and suffer from infertility. Many women with PCOS have a decreased sensitivity to insluin for which their bodies compensate by overproducing insulin. The resulting high levels of insulin may contirbute to excessive productions of androgens (male hormones, such as testosterone) and contribute to ovulation disorders.
In addition to reproductive problems, women with PCOC have a higher chance of developing medical problems such as Type 2 (non-insulin dependent) diabetes, high blood pressure, and heart disease. By the age of 40, up to 40% of PCOS patients develop impaired glucose tolerance or clinical diabetes. Given the strong evidence that excess insulin plats a role in the development of PCOS, it is reasonable to assume that reducing circulating levels of insulin may help restore normal reproductive function. Thhis may be accomplished by weight loss, improved nutrition and exercise. These behavioual changes should be the first lines of therapy for an overweight woman with PCOS.
Recently, new drugs approved by the FDA for the treatment of Type 2 diabetes have shown promise for PCOS. These drugs, known as insulin sensitizing agents, have been shown to improve the body's response to insulin, thereby reducing the need for excess insulin and restoring the levels to normal. The best studied insulin sensitizing agent available for women with PCOS is Metformin. Metformin is a biguanide medication that lowers blood sugar levels by:
* Decreasing the amount of sugar produced by the liver.
*Increasing the amount of sugar absorbed by muscle cells and decreasing the body's resistance to insluin (insulin resistance).
It does not cause the pancreas to produce more insulin and when taken alone will not cause low blood sugar (hypoglycemia). Metformin may reduce the amount of fat in the bloodstream and lower fat (triglyceride) levels and has been shown to reduce certain abnormal clotting factors and markers of inflammation that can lead to hardening of the arteries.
Metformin can be used to treat women with PCOS who have not been able to keep their blood sugar levels within a safe range by eating a healthy diet, losing weight and exercising regularly. It is effective in reducing blood sugar levels in type 2 diabetes and PCOS. It also reduces the risk of diabetes complications in overweight women. Women who are overweight do not gain weight while taking metformin.
The most common side effects of Meformin are:
*Temporary nausea.
*Loss of appetitie.
*Diarrhea.
*Increased abdominal gas.
*A metallic taste.
These side effects occur 10% oe 30% of the time. Side effects usually decrease over time. The dosage of Metformin is usually increased gradually to prevent these possible side effects.
More clinical studies are needed to determine the outcomes, risks, and complications when these medications are used to treat PCOS. Although from clinical studies have been encouraging the use of these medications in women with PCOS is still considered investigational. In general, Metformin is used as the first insulin sensitizing agent; thiasolidinediones may be considered if Metformin is ineffective or not toerated by the patient. Present data suggest the use of insulin sensitizing agents for ovulation inductions in PCOS patients who want to concieve. Because these medicines correct the underlying meabolic abnormalities associated with PCOS, it is plausible that their longtime use may delay the emergence or reduce the likeihood of developing Type 2 diabetes and cardiovascular disease.
|
