L. Ibanez et al., Sensitization to insulin induces ovulation in nonobese adolescents with anovulatory hyperandrogenism, J CLIN END, 86(8), 2001, pp. 3595-3598
In nonobese girls with an adolescent variant of polycystic ovary syndrome,
insulin-sensitizing treatment reduces hyperinsulinism, dyslipidemia, and hy
perandrogenism and restores eumenorrhea; however, the effect on anovulation
is unknown. We assessed whether metformin treatment is capable of inducing
ovulation in nonobese adolescents with anovulatory hyperandrogenism after
precocious pubarche.
The study population consisted of 18 adolescents (mean age, 16 yr; body mas
s index, 21.4 kg/m(2); 3-7 yr beyond menarche) with hyperinsulinemic hypera
ndrogenism. All girls received metformin for 6 months in a daily dose of 12
75 mg. Before inclusion, persistent anovulation was documented by weekly se
rum progesterone measurements less than 4 ng/ml (months -3 and -1); the ovu
lation rate was assessed similarly after 2,4 and 6 months on metformin; a p
remenstrual progesterone level greater than 8 ng/ml was used as ovulation m
arker.
Regular menses were reported by 16 of 18 girls within 4 months on metformin
, and all girls were eumenorrheic after 6 months on metformin. Of the 18 gi
rls, 1 (6%) ovulated after 2 months on metformin, 7 (39%) after 4 months, a
nd 14 (78%) after 6 months; ovulation induction failed in the girls with th
e lowest birth weight or most severe hyperandrogenism. Metformin treatment
was well tolerated.
In conclusion, sensitization to insulin was found to be an effective approa
ch to induce ovulation in nonobese adolescents with anovulatory hyperandrog
enism.