Metformin and pioglitazone in polycystic ovarian syndrome: a comparative study.

OBJECTIVES: To evaluate the effect of metformin and pioglitazone on insulin resistance, ovulation and hyperandrogenism in women with PCOS. METHODS: 100 patients of age 18-30 years were included in this randomised double blind trial for treatment with either metformin or pioglitazone for a period of 6 months. RESULTS: Administration of metformin and pioglitazone for 6 months revealed that 50 % of the patients achieved menstrual cyclicity. A decline in F-G grading for hirsutism within the both the groups was observed. The lipid profile also showed a decrease in total cholesterol, an increase in HDL-C, a decrease in VLDL-C levels but more so in the pioglitazone group. HOMA-IR declined more than 50-55 % with pioglitazone and 15 % with metformin. Thus, pioglitazone may be a better treatment option as far as protection from tendency to development of diabetes is conscerned. The rise in serum SHBG levels and decline in free androgen index and L/H ratio are more remarkable with pioglitazone (P < 0.05). Ovulation was restored in 44.2 and 56 % of patients on metformin and pioglitazone, respectively. CONCLUSION: Pioglitazone may be a new alternative for use in women with PCOS, providing more metabolic and reproductive benefits and possibly protection from developing diabetes and cardiovascular problem.