https://orcid.org/0000-0003-4595-7191
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Francis de Zegher, Lourdes Ibáñez, Letter to the Editor From de Zegher and Ibáñez: “Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis”, The Journal of Clinical Endocrinology & Metabolism, Volume 109, Issue 10, October 2024, Page e1966, https://doi.org/10.1210/clinem/dgae330
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Melin et al are to be lauded for their exemplary summary of the evidence on treatment of polycystic ovary syndrome (PCOS) with metformin and/or combined oral contraceptive pills (COCP) (1). The authors conclude that, for women with PCOS, the choice of metformin or COCP treatment should be based on symptoms (1). In view of the evidence and the conclusion distilled by Melin et al (1), the present letter considers which of these 2 options could be appropriate for adolescent girls with PCOS, given that adolescence may be the time window par excellence to revert an early PCOS phenotype toward normal (2-4).
Melin et al (1) mention 4 studies (5-8) that compared the outcomes of treatment (for only 6 months in (5, 6, 8)) with COCP vs metformin (1700 or 2000 mg/d) in adolescent girls with PCOS (and with obesity in most cases, as body mass index averaged between 33.4 and 40.1 kg/m2). In these 4 studies, there were no consistent COCP-vs-metformin differences in the improvement of key symptoms such as hirsutism and menstrual irregularity. Which option then leads to the more physiological state? On this point, Hoeger et al (6) are to be commended for evidencing that 75% of the cycles-on-metformin were ovulatory while 100% of the cycles-on-COCP were assumed to be anovulatory. There is thus a clinical rationale to prioritize metformin as the more physiological option.
