使用metformin或避孕藥於多囊性卵巢之比較

使用metformin (glucophage) 或避孕藥(pill)於多囊性卵巢之比較
pill較有效於改善月經異常及減少男性賀爾蒙
metformin 較有效於改善空腹胰島素及三甘油脂，
二者對於血糖及膽固醇之作用類似
http://humrep.oxfordjournals.org/content/22/5/1200.full


Metformin versus oral contraceptive pill in polycystic ovary syndrome: a Cochrane review

1. Michael F. Costello1,2,3,6, 
2. Bhushan Shrestha1, 
3. John Eden1, 
4. Neil P. Johnson4and 
5. Peter Sjoblom5

+Author Affiliations

1. ¹Division of Obstetrics and Gynaecology, School of Women's and Children's Health, University of New South Wales, Royal Hospital for Women, Sydney, NSW, 2031, Australia
2. ²Department of Reproductive Medicine, Royal Hospital for Women, Sydney, NSW, Australia
3. ³IVFAustralia, Sydney, NSW, Australia
4. ⁴National Women's Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
5. ⁵Fertility Centre Scandinavia, Stockholm Storangsvagen 10, Stockholm, Sweden

1. 6To whom correspondence should be addressed at: Division of Obstetrics and Gynaecology, School of Women's and Children's Health, Level 1 Women's Health Institute, Royal Hospital for Women, Locked Bag 2000, Randwick, Sydney, NSW 2031, Australia. Fax: 61 2 9382 6444; E-mail: mfcostello@unsw.edu.au

• Received November 29, 2006.
• Accepted January 3, 2007.

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Abstract

BACKGROUND The object of this review was to compare metformin versus oral contraceptive pill (OCP) treatment in polycystic ovary syndrome.

METHODS A systematic review and meta-analysis employing the principles of the Cochrane Menstrual Disorders and Subfertility Group was undertaken.

RESULTS Four randomized controlled trials (RCTs) (104 subjects) were included. Limited data demonstrated no evidence of a difference in effect between metformin and the OCP on hirsutism, acne or development of type 2 diabetes mellitus. There were no trials assessing diagnosis of cardiovascular disease or endometrial cancer. Metformin, in comparison with the OCP, was less effective in improving menstrual pattern [Peto odds ratio (OR) 0.08, 95% confidence interval (CI) 0.01–0.45) and in reducing the serum total testosterone level weighted mean difference (WMD) 0.54, 95% CI 0.22–0.86] but more effective in reducing fasting insulin (WMD −3.46, 95% CI − 5.39 to −1.52) and not increasing fasting triglyceride (WMD −0.48, 95% CI − 0.86 to −0.09) levels. Limited data demonstrated no evidence of a difference in effect between the two therapies on reducing fasting glucose or total cholesterol levels and severe adverse events.

CONCLUSIONS The limited RCT evidence to date does not show adverse metabolic risk with the use of the OCP compared with metformin. Further long-term RCTs are required.