Metfornim and Pioglitazone in polycystic ovarian syndrome: A comparative study

Background: Polycystic Ovarian Syndrome (PCOS) is a heterogenous collection of symptoms and signs, which form a spectrum of a disorder with a mild presentation and severe disturbance of reproductive, endocrine and metabolic function. Aim: To compare between metformin and Pioglitazone in treating polycystic ovarian syndrome. Materials and methods: This was a double blinded, randomized comparative study conducted at Government hospital Nizamabad and CKM Hospital, Warangal. 150 PCOS patients in the age group 18-35 years were enrolled, and were allocated to two groups and were given the following modalities for a period of 8 months. Group I: Metformin-500 mg, BID, Group II: Pioglitazone-15 OD. Each group consisted of 75 patients. The minimum sample size required was 50-60. In this study, 75 patients were included in each group to allow dropouts. Oligo or anovulation, hyperandrogenism, polycystic ovaries were included. Results: In group I, 68 (90%) out of 75 patients and in group II, 67(89%) out of 75 patients completed the trial. In group I, all the 68 patients had irregular menstrual cycles at the beginning of the study, and at the end of the study, 34 (47%) had regular menstrual cycles. In group II, 67 patients had irregular menstrual cycles at the beginning of the study, and at the end of the study, 38 (56%) had regular menstrual cycles. In both the groups, there was an increase in HDL levels (statistically significant versus baseline), more in Group II than in Group I. The average increase is 28 % in Group I as compared to 74 % in Group II. There is a trend of decrease in VLDL levels in both groups, the decrease being more in Group II (48 %) than in Group I (26 %) statistically significant when both groups were compared. In both the groups, there was a rise in SHBG, (statistically significant versus baseline). In Group I, the mean increase in SHBG was 6.22 nmol/l (22 %), but in Group II, mean rise in SHBG was more, i.e.34.56 nmol/l (72.7 %) and this difference is statistically significant (P<0.05). Both the Groups showed a decrease in LH/FSH ratio. The fall in LH/FSH ratio was more in Group II, than in Group I. This fall in Group II was statistically significant P<0.05 versus Group I. Conclusion: Pioglitazone can restore menstrual cycle, a better ovulatory rate is achieved, clinical signs of hyperandrogenism are improved, and type 2 diabetes is prevented or delayed, so pioglitazone is a better treatment in patients with PCOS.