Comparison of Efficacy of Spironolactone with Metformin in the Management of Polycystic Ovary Syndrome: An Open-Labeled Study

• Published in: The journal of clinical endocrinology and metabolism Vol. 89; no. 6; pp. 2756 - 2762
• Main Authors: Ganie, M. Ashraf, Khurana, M. L., Eunice, M., Gulati, M., Dwivedi, S. N., Ammini, A. C.
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01-06-2004; Copyright Oxford University Press
• Subjects: Adolescent; Adult; Biological and medical sciences; Body Mass Index; Endocrinopathies; Feeding. Feeding behavior; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Humans; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Medical sciences; Metformin - administration & dosage; Metformin - adverse effects; Mineralocorticoid Receptor Antagonists - administration & dosage; Mineralocorticoid Receptor Antagonists - adverse effects; Polycystic Ovary Syndrome - drug therapy; Spironolactone - administration & dosage; Spironolactone - adverse effects; Treatment Outcome; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Nutrition; Label; Female sterility; Metabolic diseases; Polycystic ovary; Female genital diseases; Ovarian diseases; Treatment; Spironolactone; Cyst; Benign neoplasm; Metformin; Endocrinology; Comparative study
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2003-031780

We compared the efficacy of spironolactone (50 mg/d) with metformin (1000 mg/d) after random allocation in 82 adolescent and young women with polycystic ovary syndrome (PCOS) on body mass index (BMI), waist-to-hip ratio, blood pressure, menstrual cyclicity, hirsutism, hormonal levels, glycemia, and insulin sensitivity at baseline and at the 3rd and 6th months of treatment. Sixty-nine women who completed the follow-up had a mean age of 22.6 ± 5.0 yr and mean BMI of 26.8 ± 4.0 kg/m2. The number of menstrual cycles in the spironolactone and metformin groups increased from 6.6 ± 2.1 and 5.7 ± 2.3 at baseline to 9.0 ± 1.9 and 7.4 ± 2.6 at 3rd month and to 10.2 ± 1.9 and 9.1 ± 2.0/ year at the 6th month (P = 0.0037), respectively. The hirsutism score decreased from 12.9 ± 3.2 and 12.5 ± 4.9 at baseline to 10.1 ± 3.1 and 11.4 ± 4.1 at the 3rd month and to 8.7 ± 1.9 and 10.0 ± 3.3 at the 6th month, respectively. Both groups showed improvement in glucose tolerance and insulin sensitivity, although the metformin effect was significant in the latter. Serum LH/FSH and testosterone decreased in both groups. BMI, waist-to-hip ratio, and blood pressure did not change with either drug. We conclude that both drugs are effective in the management of PCOS. Spironolactone appears better than metformin in the treatment of hirsutism, menstrual cycle frequency, and hormonal derangements and is associated with fewer adverse events.