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Polycystic ovary syndrome - Management
Basis for recommendation
- Guidelines from the Royal College of Obstetricians and Gynaecologists make the following points about the use of these drugs in women with polycystic ovary syndrome [RCOG, 2007]:
- There is no evidence of long-term benefit.
- Evidence suggests that metformin may have short-term effects on insulin resistance in women without diabetes.
- Metformin may reduce androgen levels by about 11% compared with placebo.
- Evidence regarding metformin and reduction in body weight is conflicting.
- Women with a body mass index greater than 37 kg/m2 may not respond to metformin.
- No evidence supports the use of insulin-sensitizing drugs in the prevention of cardiovascular disease.
- Evidence suggests that metformin is no better than diet and lifestyle at improving metabolic risk and progression to Type 2 diabetes.
- There has been recent concern that myocardial infarction and death are increased in women with diabetes treated with rosiglitazone.
- Metformin and the thiazolinediones are unlicensed for use in polycystic ovary syndrome.
- As there is uncertainty about the benefits and safety of insulin-sensitizing drugs, CKS recommends that they be initiated by a specialist.
- There is no expert consensus on which women should be referred for treatment with metformin.
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