Polycystic ovarian syndrome treatment

Metformin works best in patients with significant hyperglycemia and is often considered first-line therapy in the treatment of mild to moderate type II overweight diabetics who demonstrate insulin resistance. The United Kingdom Prospective Diabetes Study demonstrated a marked reduction in cardiovascular comorbidities and diabetic complications in metformin-treated individuals. Metformin has also been used to treat hirsutism in individuals with polycystic ovarian syndrome and may enhance fertility in these women, perhaps by decreasing androgen levels and enhancing insulin sensitivity. 

Jirecek S, Nagele F, Huber JC, Wenzl R. Ovarian hyperstimulation syndrome caused by GnRH-analogue treatment without gonadotropin therapy in a patient with polycystic ovarian syndrome. Acta Obstet Gynecol Scand 1998 77(9) 940-1. 

Polycystic ovarian syndrome and menstrual irregularities were more prevalent in those taking valproate within a population of 71 women with epilepsy who had taken antiepUeptic drugs for a minimum of 2 years [385. There was no correlation between dose and duration of treatment and the probabilities of such complications. 

OHSS is characterized by cystic ovarian enlargement, increased capillary permeability, and third space fluid accumulation (that is in an extracellular compartment that is not in equilibrium with either the extracellular or intracellular fluid, for example the bowel lumen, subcutaneous tissues, retroperitoneal space, or peritoneal cavity). Risk factors include a previous history of OHSS, age under 30 years (probably because more follicles are available), and polycystic ovary syndrome. Non-pregnant patients usually recover within 14 days with supportive treatment. The severe form (with ascites or pleural effusion and hemoconcentration) occurs in 1-10% of patients (64,65). In critical cases, hypoxemia, renal insufficiency, thromboembolism, and rarely death can occur (66). 

Polycystic ovary syndrome (polycystic ovaries, hjrper-androgenism, obesity, hirsutism, anovulatory cycles, and menstrual disorders) is more common in women with epilepsy. Valproate has been associated with alterations in reproductive hormonal function beginning in the first month of treatment. Serum androgen concentrations increase in patients taking valproate but the profile of hormonal changes is different in women and men (97). Animal studies have corroborated the adverse ovarian and endocrine effects of valproate (98). Four review articles have dealt with this reported adverse event, highlighting controversial views (99-102). 

Cataldo NA, Abbasi F, Mclaughlin TL, et al. Metabohe and ovarian effects of rosightazone treatment for 12 weeks in insuhn-resistant women with polycystic ovary syndrome. Hum Repro 2006 1 109-120. 

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