Insulin and Oral Antidiabetic Agents for Treatment of Polycystic Ovary Syndrome

Naci K. Kuscu, MD, and Faik M. Koyuncu, MD

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Abstract and Introduction

Insulin plays a major role in polycystic ovary syndrome (PCOS). Insulin resistance and resultant hyperinsulinemia stimulate both the ovary and adrenal to produce androgens. Oral antidiabetic agents have been used to alleviate the symptoms and to induce ovulation in women with PCOS. This review focuses on the relation between insulin and PCOS and discusses the use of oral antidiabetic agents.

Polycystic ovary syndrome (PCOS) is characterized by chronic menstrual irregularity (amenorrhea or oligomenorrhea), hirsutism, hyperinsulinemia, and infertility, and affects nearly 6% of women of reproductive age.[1] The exact pathogenesis is still unknown, but oligomenorrhea and infertility result from anovulation, and hirsutism is the result of both ovarian and adrenal hyperactivity. About 40% to 70% of patients with PCOS have increased levels of adrenal androgens.[2] Hyperresponsiveness of adrenal to corticotropin (ACTH), increased ACTH production, decreased endogenous opioids, hypersecretion of catecholamines, or hyperprolactinemia may contribute to the increased adrenal activity.[3] Obesity does not seem to affect pathophysiology of PCOS.[4]

What is the relation between hyperandrogenism and hyperinsulinemia? Does an elevated androgen level cause hyperinsulinemia or vice versa? One study has shown that gonadotropin-releasing hormone agonist (GnRHa) therapy suppressed androgens in subjects with PCOS, but no change in insulin resistance was observed[5]; when hyperinsulinemia is reduced, however, androgen levels fall,[6] indicating that it is insulin that induces hyperandrogenism.

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