COMPARISON OF SPIRONOLACTONE PLUS METFORMIN VERSUS ORAL CONTRACEPTIVES IN PCOS

Background: Androgen excess is a major mechanism leading to polycystic ovary syndrome (PCOS) yet, insulin resistance and obesity are frequently found in these women explaining the association of this syndrome with diabetes and increased cardiovascular risk factors. Accordingly, current strategies for the treatment of PCOS include amelioration of androgen excess using combined oral contraceptives (COC) and/or antiandrogens and insulin sensitizers such as metformin.

Objectives: To see the effect of combined therapy with low-dose spironolactone plus metformin versus oral contraceptives in Polycystic Ovary Syndrome (PCOS) patients.

Methods: All subjects included had menstrual disturbances and Hirsutism after ruling out disorders such as Cushings syndrome, nonclassical adrenal hyperplasia, thyroid dysfunction, hyperprolactinemia, and androgen-secreting tumors.Blood samples were collected from the patients after an overnight fast for the estimation of T4, TSH, LH, FSH, prolactin (PRL), blood counts, electrolytes, lipids, liver, and kidney functions. Blood samples for hormonal investigations were collected from d 3-7 (early follicular phase) in subjects with spontaneous menstrual cycles.

Results: Menstrual cycle frequency improved significantly (P = 0.01) in all the three groups at 6 months. The hirsutism was significantly decreased in group II and menstrual cycle frequency improved significantly (P = 0.005) in group III at 6 months. There was significant decrease in Testosterone levels in group III, with no significant effect on LH, FSH, LH/FSH, PRL, TSH and Fasting insulin levels.

Conclusion: Combination therapy is more effective than metformin alone for symptoms of polycystic ovarian syndrome.