Abstract
Abstract Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting between 4% and 8% of reproductive aged women. Although the symptoms and signs of PCOS are very heterogeneous, the syndrome usually presents with any combination of the following, menstrual irregularities (usually oligomenorrhea or amenorrhea), signs of hyperandrogenism (hirsutism, acne, alopecia) a characteristic appearance of the ovaries on ultrasound examination and an endocrine disturbance often involving high serum concentrations of LH and androgens. There is a well established association between PCOS, insulin resistance and hyperinsulinemia. Insulin resistance is a pivotal defect in PCOS probably counts as one of the most important advances in the battle to control the disorder. This metabolic abnormality leads to a compensatory increase in circulating insulin and this elevated insulin level directly stimulates the ovary to produce excess androgens. It also decreases hepatic sex hormone binding globulin (SHBG), so increasing biologically available free testosterone concentration in the circulation. This metabolic derangement leads to oligomenorrhea and anovulation. Different insulin sensitizers are used to revert the hyperinsulinemic condition. Metformin is top of them, which proved to enhance ovulation in insulin resistant PCOS when used with different ovulation inducing agents. Metformin reduces insulin resistance of peripheral tissue and allows muscle and adipose cells to take in glucose at normal insulin levels. It inhibits hepatic glucose production, decreases intestinal absorption and promotes glucose uptake, utilization by peripheral tissues at the postreceptor level. In this way it reduces insulin level and subsequently androgen level. It is easily available, safe and no teratogenic or adverse fetal outcome were reported by any researcher. It can be used safely in clomiphene resistant PCOS patients.
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