NEW YORK (Reuters Health) - Adolescents with polycystic ovarian syndrome (PCOS) may be treated with metformin or with oral contraceptives, depending on symptoms and patient preferences, researchers report. (多囊性卵形症候群(PCOS)的治療, 可以使用Metformin或是口服避孕藥, 需根據患者的狀況。)

PCOS presents with a constellation of symptoms, including chronic anovulation, clinical features of hyperandrogenism, polycystic ovaries, and features of metabolic syndrome, according to Dr. Reem A. Al Khalifah, of King Saud University in Saudi Arabia, and colleagues.

"The Endocrine Society guidelines for the treatment of adults with PCOS recommends using oral contraceptive pills (OCPs) to control symptoms of hyperandrogenism, while reserving metformin for cases with impaired glucose tolerance or features of metabolic syndrome. However, there is lack of evidence to support the best first-line medication in adolescents with PCOS," they write in Pediatrics, online April 28.

To investigate, the team conducted a systematic review and meta-analysis of randomized, controlled trials (RCTs) to evaluate the use of metformin versus OCPs for the treatment of PCOS in adolescents ages 11 to 19. The team searched Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials, and other data sources, such as conference proceedings, up to January 29, 2015.

Four RCTs met the inclusion and exclusion criteria. The reviewed evidence came from 170 patients. OCP treatment resulted in modest improvement in menstrual cycle frequency (weighted mean difference = 0.27) and mild reduction of acne scores (WMD = 0.3).

Metformin resulted in greater body mass index reduction (WMD = 4.02), decreased dysglycemia prevalence (risk ratio 0.41), and improved total cholesterol and low-density lipoprotein (LDL) levels.

Metformin and OCPs were similar in terms of impact on hirsutism.

Overall, Dr. Al Khalifah told Reuters Health by email, "we found that oral contraceptive pills provided modest improvement in menstrual cycle frequency, while metformin decreased prevalence of diabetes and prediabetes, decreased body mass index, and improved total cholesterol and LDL levels."

However, echoing the study conclusions, Dr. Al Khalifah stressed that the current evidence is derived from very low to low quality evidence, and so "treatment choice should be guided by patient values and preferences, while balancing potential side effects."

Dr. Jennifer Austin Conti, an obstetrician-gynecologist with Stanford University, told Reuters Health by email, "It's great that they did both a systematic review and meta-analysis comparing these two treatments, which I know pediatricians often struggle with. But the review turned up only sparse data, comprised of a small number of patients, so unfortunately there is not much to work with here."

"PCOS is a spectrum, with some girls having obesity and hairiness, and others being slim with no hair and just abnormal cycles," Dr. Conti observed. "So depending on the symptoms (oral contraceptives are better for acne and regulating menstrual cycles, while metformin is better for weight loss), each person may require a different medication, either OCPs or metformin. This study confirms that it's okay to choose one or the other, depending on what you're trying to treat."

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/1QCGG2u

Pediatrics 2016.