English

Abstract

OBJECTIVES: To compare and evaluate the effects of metformin and pioglitazone on insulin resistance, ovulation and hyperandrogenism in women with PCOS. METHODS: Total 180 patients were included in this double blind controlled trial between 18 to 30 years. These women were randomly allocated in two groups. After taking written consent they were treated with either metformin or pioglitazone for 6 months and pretreatment versus post treatment clinical and biochemical variables were analysed and compared. RESULTS: After treatment with metformin and pioglitazone around 5055 % women in both group achieved menstrual cycle regularity , and ovulation was restored in 44 % and 55 % in patients on metformin and pioglitazone respectively. Both group showed decline in F-G score. Decrease in serum cholesterol was seen in both groups , but was more pronounced with pioglitazone. Effect on insulin resistance and hyperinsulinemia was assessed by measuring pre and post treatment fasting serum insulin levels . Fall in serum insulin level was more with pioglitazone and 48 % women became normoinsulinemic after treatment with pioglitazone as compared to 12 % with metformin. Rise in serum SHBG and fall in LH level was more remarkable with pioglitazone (p value < 0.05). CONCLUSION: Pioglitazone has remarkable beneficial effect on hyperinsulinemia, hyperandrogenism and ovulation in women with PCOS.. Along with this metabolic and reproductive benefit it has preventive action on risk of development of type 2 diabetes and cardiovascular problems. So it may come up as new treatment modality for metabolic correction in PCOS. INTRODUCTION: Polycystic ovarian syndrome being heterogenous disorder affect 7-10% of population1,2. It is spectrum of disorders with mild presentation in some and severe reproductive and metabolic disturbances in others, PCOS is characterized by chronic anovulation or hypo ovulation, hyperandrogenism ( clinical or biochemical) , and or on ultrasonography cystic enlarged ovaries. Peri or post pubertal obesity, insulin resistance and consequent hyperinsulinemia are important comorbidities of PCOS and can aggrevate hyperandrogenism. Data that support pathogenic role of hyperinsulinemia as 1. At central level insulin causes deregulation of LH secretion,