Skip to main content
Log in

Metformin und das Syndrom der polyzystischen Ovarien

Metformin and polycystic ovary syndrome

  • Arzneimitteltherapie
  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Entsprechend den Rotterdam-Kriterien ist das Syndrom der polyzystischen Ovarien (PCOS) durch Hyperandrogenämie und/oder Hirsutismus, Störungen im Menstruationszyklus und sonographisch durch eine Hypertrophie des Stromaanteils der Ovarien gekennzeichnet. Obwohl Insulinresistenz und Hyperinsulinämie in diesem Zusammenhang kein integraler Bestandteil des Krankheitsbilds und auch nicht Teil der Diagnosekriterien sind, wird bei einer Mehrheit der Patientinnen mit PCOS doch eine verminderte Sensitivität für Insulin postuliert. Bei Patientinnen mit Diabetes und Insulinresistenz senkt Metformin erfolgreich die Insulinsekretion. Zu diesem Zweck wurde auch Metformin nicht nur bei Diabetes mellitus, sondern auch bei der Behandlung von normal- und übergewichtigen Frauen mit PCOS eingesetzt. Zusammen mit unterstützenden Maßnahmen zur Änderung der Lebensgewohnheiten hat sich Metformin als wirksam bei der Verminderung des Körpergewichts und bei der Abnahme der Fettmasse im Körper erwiesen. Zudem bewirkt Metformin bei einer Mehrheit der Betroffenen mit PCOS eine Verbesserung der hyperandrogenen Stigmata und in der Folge auch ein Wiedereinsetzen regelmäßiger Menstruationszyklen. Aufgrund der besseren Wirksamkeit von Clomifencitrat oder Letrozol bei der Behandlung der chronischen Anovulation ist Metformin allerdings ungenügend wirksam, um als Monosubstanz oder zusammen mit einer der beiden anderen Substanzen eine signifikante Verbesserung der Schwangerschafts- und Lebendgeburtenrate zu erzielen.

Abstract

According to the Rotterdam criteria, polycystic ovary syndrome (PCOS) is characterized by hyperandrogenemia and/or hirsutism, disorders of the menstrual cycle and sonographically by hypertrophy of the stromal part of the ovaries. Although insulin resistance and hyperinsulinemia in this context are not an integral component of the symptom picture and also not part of the diagnostic criteria, a reduced sensitivity for insulin is postulated in the majority of patients with PCOS. In patients with diabetes and insulin resistance, metformin successfully reduces insulin secretion. For this reason metformin is used not only for diabetes mellitus but also for the treatment of normal and overweight women with PCOS. Together with the supporting measures for changing the normal habits, metformin has proven to be effective in the reduction of body weight and the loss of fat mass in the body. In addition, in the majority of patients with PCOS metformin results in an improvement of the hyperandrogenic stigmata and subsequently the reinstatement of a regular menstrual cycle. Due to the better effectiveness of clomifene citrate and letrozole in the treatment of chronic anovulation, metformin is, however, insufficiently effective as monosubstance or together with one of the other two substances to achieve a significant improvement in the pregnancy and live birth rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

Verwendete Literatur

  1. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19:41–47

    Article  Google Scholar 

  2. Kakoly NS, Khomami MB, Joham AE, Cooray SD, Misso ML, Norman RJ, Harrison CL, Ranasinha S, Teede HJ, Moran LJ (2018) Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression. Hum Reprod Update. https://doi.org/10.1093/humupd/dmy007

    Article  PubMed  Google Scholar 

  3. Merz CN, Shaw LJ, Azziz R, Stanczyk FZ, Sopko G, Braunstein GD, Kelsey SF, Kip KE, Cooper-DeHoff RM, Johnson BD, Vaccarino V, Reis SE, Bittner V, Hodgson TK, Rogers W, Pepine CJ (2016) Cardiovascular disease and 10-year mortality in postmenopausal women with clinical features of polycystic ovary syndrome. J Womens Health 25:875–881

    Article  Google Scholar 

  4. Cooney LG, Lee I, Sammel MD, Dokras A (2017) High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 32:1075–1091

    Article  PubMed  Google Scholar 

  5. Silfen ME, Denburg MR, Manibo AM, Lobo RA, Jaffe R, Ferin M, Levine LS, Oberfield SE (2003) Early endocrine, metabolic, and sonographic characteristics of polycystic ovary syndrome (PCOS): comparison between nonobese and obese adolescents. J Clin Endocrinol Metab 88:4682–4688

    Article  PubMed  CAS  Google Scholar 

  6. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E; American Association of Clinical Endocrinologists (AACE); American College of Endocrinology (ACE); Androgen Excess and PCOS Society. American Association Of Clinical Endocrinologists, American College Of Endocrinology, And Androgen Excess And Pcos Society Disease State Clinical Review: Guide To The Best Practices In The Evaluation And Treatment Of Polycystic Ovary Syndrome – PART 2. Endocr Pract. 2015;21:1415–1426.

  7. Bailey CJ (2017) Metformin: historical overview. Diabetologia 60:1566–1576

    Article  PubMed  CAS  Google Scholar 

  8. Schweizer Arzneimittelkompendium. https://compendium.ch

  9. Vanky E, Stridsklev S, Heimstad R, Romundstad P, Skogøy K, Kleggetveit O, Hjelle S, von Brandis P, Eikeland T, Flo K, Berg KF, Bunford G, Lund A, Bjerke C, Almås I, Berg AH, Danielson A, Lahmami G, Carlsen SM (2010) Metformin versus placebo from first trimester to delivery in polycystic ovary syndrome: a randomized, controlled multicenter study. J Clin Endocrinol Metab 95:E448–E455

    Article  PubMed  CAS  Google Scholar 

  10. Najafi M, Cheki M, Rezapoor S, Geraily G, Motevaseli E, Carnovale C, Clementi E, Shirazi A (2018) Metformin: Prevention of genomic instability and cancer: a review. Mutat Res 827:1–8

    Article  PubMed  CAS  Google Scholar 

  11. Moran LJ, Hutchison SK, Norman RJ, Teede HJ (2011) Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007506.pub2

    Article  PubMed  Google Scholar 

  12. Naderpoor N, Shorakae S, de Courten B, Misso ML, Moran LJ, Teede HJ (2015) Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis. Hum Reprod Update 21:560–574

    Article  PubMed  CAS  Google Scholar 

  13. Morin-Papunen L, Vauhkonen I, Koivunen R, Ruokonen A, Martikainen H, Tapanainen JS (2003) Metformin versus ethinyl estradiol-cyproterone acetate in the treatment of nonobese women with polycystic ovary syndrome: a randomized study. J Clin Endocrinol Metab 88:148–156

    Article  PubMed  CAS  Google Scholar 

  14. Luque-Ramírez M, Nattero-Chávez L, Ortiz Flores AE, Escobar-Morreale HF (2017) Combined oral contraceptives and/or antiandrogens versus insulin sensitizers for polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. https://doi.org/10.1093/humupd/dmx039

    Article  PubMed  Google Scholar 

  15. Lee JK, Smith AD (2017) Metformin as an adjunct therapy for the treatment of moderate to severe acne vulgaris. Dermatol Online J 23:13030/qt53m2q13s

    PubMed  Google Scholar 

  16. Eisenhardt S, Schwarzmann N, Henschel V, Germeyer A, von Wolff M, Hamann A, Strowitzki T (2006) Early effects of metformin in women with polycystic ovary syndrome: a prospective randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab 91:946–952

    Article  PubMed  CAS  Google Scholar 

  17. Yang PK, Hsu CY, Chen MJ, Lai MY, Li ZR, Chen CH, Chen SU, Ho HN (2018) The efficacy of 24-month metformin for improving menses, hormones, and metabolic profiles in polycystic ovary syndrome. J Clin Endocrinol Metab 103:890–899

    Article  PubMed  Google Scholar 

  18. Misso ML, Costello MF, Garrubba M, Wong J, Hart R, Rombauts L, Melder AM, Norman RJ, Teede HJ (2013) Metformin versus clomiphene citrate for infertility in non-obese women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 19:2–11

    Article  PubMed  CAS  Google Scholar 

  19. Practice Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrm.org; Practice Committee of the American Society for Reproductive Medicine. Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline. Fertil Steril. 2017;108:426–441.

  20. Bordewijk EM, Nahuis M, Costello MF, Van der Veen F, Tso LO, Mol BW, van Wely M (2017) Metformin during ovulation induction with gonadotrophins followed by timed intercourse or intrauterine insemination for subfertility associated with polycystic ovary syndrome. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009090.pub2

    Article  PubMed  Google Scholar 

Weiterführende Literatur

  1. Ruan X, Kubba A, Aguilar A, Mueck AO (2017) Use of cyproterone acetate/ethinylestradiol in polycystic ovary syndrome: rationale and practical aspects. Eur J Contracept Reprod Health Care 22:183–190

    Article  PubMed  CAS  Google Scholar 

  2. Zhao Y, Ruan X, Mueck AO (2017) Letrozole combined low dose highly purified HMG for ovulation induction in clomiphene citrate-resistant infertile women with polycystic ovary syndrome: a prospective study. Gynecol Endocrinol 33:462–466

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christian De Geyter.

Ethics declarations

Interessenkonflikt

C. De Geyter, F. Emch und A. Ahler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

M. Birkhäuser, Basel

B. Imthurn, Zürich

A.O. Mueck, Tübingen

O. Ortmann, Regensburg

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Geyter, C., Emch, F. & Ahler, A. Metformin und das Syndrom der polyzystischen Ovarien. Gynäkologische Endokrinologie 16, 191–194 (2018). https://doi.org/10.1007/s10304-018-0194-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10304-018-0194-y

Schlüsselwörter

Keywords

Navigation