Polycystic ovarian syndrome: early treatment may prevent subfertility

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New research presented at ENDO 2017 this week suggests a combination of spironolactone, pioglitazone and metformin may improve ovulation.

No treatment is licensed for polycystic ovary syndrome (PCOS) but an estimated 98 per cent of adolescents with PCOS receive an oral contraceptive (OC). Findings from a new study  presented at ENDO 2017 , suggest the low-dose combination of spironolactone-pioglitazone-metformin (SPIOMET) could be more effective than OC at restoring ovulation and preventing future subfertility.
The study recruited 36 young women with hirsutism and oligomenorrhea, a mean age 16 years and a mean BMI 23.5Kg/m2. Participants were randomised to receive either a combined oral contraceptive pill or SPIOMET daily for 12 months, and followed-up for an additional 12 months without intervention.

Researchers found compared with OCs, SPIOMET was followed by a 2.5-fold higher ovulation rate and a six-fold higher prevalence of normovulation, and oligo-anovulation risk after SPIOMET was 65 per cent lower than after OC. Visceral fat and insulinaemia normalised only with SPIOMET, while body weight, lean mass, and abdominal subcutaneous fat mass remained stable in both treatment groups.

The authors suggested refocusing PCOS treatment towards early reduction of ectopic fat may prevent part of subsequent oligo-anovulatory subfertility.

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