Metformin versus Metformin + Pioglitazone in normal-weight women with polycystic ovary syndrome

Combining Metformin and Pioglitazone in a fixed-dose regimen proved to be convenient, inexpensive, and effective for treating normal-weight women with polycystic ovary syndrome, with the benefits of improved clinical management and increased patient compliance.

To compare the efficacy of metformin (MET) as compared to metformin when used along with pioglitazone on the gonadal and metabolic profiles in women with normal weight having polycystic ovary syndrome (PCOS).

From January to September 2022, 60 normal-weight women diagnosed with PCOS were enrolled. They were randomly divided into two groups:

• MET group: Women received metformin alone.
• Pioglitazone plus MET group: Women received pioglitazone in addition to metformin, for either 12 weeks of metformin monotherapy or combined therapy.

The anthropometric measurements, tracking the menstrual cycle changes, evaluation of gonadal profiles, and conducting the oral glucose insulin-releasing test (OGIRT) were a part of the baseline and post-treatment assessments.

This trial was completed by 36 women. Both Metformin (MET) and pioglitazone plus MET therapies led to improvements in menstrual cycles after 4 and 12 weeks of treatment, with no statistically significant variance between these groups.

The use of pioglitazone plus MET therapy significantly improved sex hormone-binding globulin (SHBG) and anti-Mullerian hormone (AMH) levels more effectively compared to monotherapy. Additionally, the details of hormonal changes with the use of these therapies have been portrayed in the following Table 1:

Also, the combination was more useful in improving the blood glucose levels at 120 and 180 minutes of OGIRT than the monotherapy (P < 0.05).

In PCOS-afflicted women with normal weight, pioglitazone +MET therapy might offer greater advantages in enhancing SHBG, AMH and postprandial glucose levels than MET monotherapy, without impacting weight. Nonetheless, further research with larger PCOS study cohorts is required to authenticate these study findings.