EFFECT OF BODY MASS INDEX ON MENSTRUAL CYCLE REGULATION IN WOMEN WITH POLYCYSTIC OVARY SYNDROME RECEIVING INSULIN-SENSITIZING THERAPY
Main Article Content
Keywords
Polycystic ovary syndrome; Body mass index; Metformin; Inositol; Menstrual cycle regulation
Abstract
Objective:To assess the influence of body mass index (BMI) on menstrual cycle regulation in women with polycystic ovary syndrome (PCOS) treated with insulin-sensitizing therapy.
Study Design Randomized controlled trial.
Place and Duration of Study:Department of Obstetrics and Gynecology, Unit III, Civil Hospital Karachi, over a period of six months.
Methodology:This study enrolled 208 women aged 15–40 years diagnosed with PCOS according to Rotterdam criteria. Participants were randomly assigned to receive either metformin alone (500 mg three times daily) or metformin combined with inositol (500 mg three times daily plus inositol 1 g twice daily). Patients were stratified into BMI categories: ≤25 kg/m², 25.1–29.9 kg/m², and ≥30 kg/m². Treatment efficacy was evaluated by achievement of three consecutive regular menstrual cycles within six months. Statistical analysis was performed using SPSS version 20.
Results:Across all BMI categories, women receiving combination therapy demonstrated significantly higher rates of menstrual cycle regularization compared to those receiving metformin alone. In participants with BMI ≤25 kg/m², menstrual regularity was achieved in 100% of patients on combination therapy versus 29.4% on metformin alone (p<0.001). Similar statistically significant outcomes were observed in overweight and obese BMI groups.
Conclusion:Body mass index did not negatively affect menstrual cycle response in women receiving combined insulin-sensitizing therapy. The addition of inositol to metformin resulted in superior menstrual regulation across all BMI categories.
Study Design Randomized controlled trial.
Place and Duration of Study:Department of Obstetrics and Gynecology, Unit III, Civil Hospital Karachi, over a period of six months.
Methodology:This study enrolled 208 women aged 15–40 years diagnosed with PCOS according to Rotterdam criteria. Participants were randomly assigned to receive either metformin alone (500 mg three times daily) or metformin combined with inositol (500 mg three times daily plus inositol 1 g twice daily). Patients were stratified into BMI categories: ≤25 kg/m², 25.1–29.9 kg/m², and ≥30 kg/m². Treatment efficacy was evaluated by achievement of three consecutive regular menstrual cycles within six months. Statistical analysis was performed using SPSS version 20.
Results:Across all BMI categories, women receiving combination therapy demonstrated significantly higher rates of menstrual cycle regularization compared to those receiving metformin alone. In participants with BMI ≤25 kg/m², menstrual regularity was achieved in 100% of patients on combination therapy versus 29.4% on metformin alone (p<0.001). Similar statistically significant outcomes were observed in overweight and obese BMI groups.
Conclusion:Body mass index did not negatively affect menstrual cycle response in women receiving combined insulin-sensitizing therapy. The addition of inositol to metformin resulted in superior menstrual regulation across all BMI categories.
References
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17. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Diabetes risk in PCOS. J Clin Endocrinol Metab. 1999;84(1):165-9.
18. Vgontzas AN, Legro RS, Bixler EO. Insulin resistance and sleep apnea in PCOS. J Clin Endocrinol Metab. 2001;86(2):517-20.
19. Hecht Baldauff N, Arslanian S. Management of PCOS in adolescents. Arch Dis Child. 2015;100(11):1076-83.
20. Badawy A, Elnashar A. Treatment options for PCOS. Int J Womens Health. 2011;3:25-35.
21. Hopkinson ZE, Sattar N, Fleming R. PCOS as metabolic syndrome. BMJ. 1998;317:329-32.
22. Holte J, Bergh T, Berne C. Insulin resistance and ovarian function in PCOS. J Clin Endocrinol Metab. 1994;78:1052-8.
23. Ehrmann DA, Barnes RB, Rosenfield RL. Impaired glucose tolerance in PCOS. Diabetes Care. 1999;22:141-6.
24. Moghetti P, Castello R, Negri C. Metformin effects on endocrine and metabolic profiles in PCOS. J Clin Endocrinol Metab. 2000;85:139.
25. Morin-Papunen LC, Vauhkonen I, Koivunen RM. Metformin in obese women with PCOS. J Clin Endocrinol Metab. 2000;85:3161.
26. Pasquali R, Gambineri A, Biscotti D. Long-term metformin in obese PCOS women. J Clin Endocrinol Metab. 2000;85:2767.
27. Harborne LR, Sattar N, Norman JE. Metformin and weight loss in obese PCOS. J Clin Endocrinol Metab. 2005;90:4593.
28. Kiddy DS, Hamilton-Fairley D, Bush A. Dietary treatment and ovarian function in obese PCOS. Clin Endocrinol (Oxf). 1992;36:105-11.
29. Tang T, Glanville J, Hayden CJ. Lifestyle modification and metformin in obese PCOS. Hum Reprod. 2006;21:80-9.
30. Nestler JE. Metformin in PCOS. N Engl J Med. 2008;358:47.
31. Lord JM, Flight IH, Norman RJ. Insulin-sensitizing drugs in PCOS. BMJ. 2003;327:951.
32. Legro RS, Arslanian SA, Ehrmann DA. Endocrine Society guideline on PCOS. J Clin Endocrinol Metab. 2013;98(12):4565-92.
33. Costello M, Shrestha B, Eden J. Insulin sensitizers vs OCPs in PCOS. Cochrane Database Syst Rev. 2007:CD005552.
34. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352:1223-36.
35. Bolumar F, Olsen J, Rebagliato M. Body mass index and delayed conception. Am J Epidemiol. 2000;151:1072-9.
2. Eisenhardt S, Schwarzmann N, Henschel V, et al. Early effects of metformin in women with PCOS. J Clin Endocrinol Metab. 2006;91(3):946-52.
3. Lord J, Thomas R, Fox B, Acharya U, Wilkin T. Effects of metformin on fat distribution and metabolic syndrome in PCOS. BJOG. 2006;113:817-24.
4. Lagana SA, Barbaro L, Pizzo A. Ovarian and metabolic effects of D-chiro-inositol in PCOS. Arch Gynecol Obstet. 2015;291:1181-6.
5. Palomba S, Falbo A, Russo T, et al. Insulin sensitivity after metformin withdrawal in PCOS. J Clin Endocrinol Metab. 2007;92(8):3128-35.
6. Sacchinelli A, Venturella R, Lico D. Inositol and NAC therapy in PCOS with or without insulin resistance. Obstet Gynecol Int. 2016;2016:2026056.
7. Hasan AJ, Memon UG. Impact of metformin therapy in PCOS. J Coll Physicians Surg Pak. 2005;15(11):712-5.
8. Zafar S. Role of metformin in hyperinsulinemia and menstrual irregularity in PCOS. J Ayub Med Coll Abbottabad. 2005;17(4):54-6.
9. Baillargeon JP, Iuorno MJ, Jakubowicz DJ, et al. Metformin and D-chiro-inositol mediator release in PCOS. J Clin Endocrinol Metab. 2004;89(1):242-9.
10. Rotterdam ESHRE/ASRM PCOS Consensus Workshop Group. Revised diagnostic criteria for PCOS. Fertil Steril. 2004;81(1):19-25.
11. Barber TM, McCarthy MI, Wass JA, Franks S. Obesity and PCOS. Clin Endocrinol (Oxf). 2006;65(2):137-45.
12. Toulis KA, Goulis DG, Farmakiotis D. Adiponectin levels in PCOS: meta-analysis. Hum Reprod Update. 2009;15(3):297-307.
13. Dunaif A, Wu X, Lee A, Diamanti-Kandarakis E. Insulin receptor signaling defects in PCOS. Am J Physiol Endocrinol Metab. 2001;281:E392-9.
14. Diamanti-Kandarakis E, Kouli CR, Bergiele AT. Hormonal and metabolic profile in PCOS. J Clin Endocrinol Metab. 1999;84(11):4006-11.
15. Ehrmann DA, Kasza K, Azziz R, et al. Metabolic status in women with PCOS. J Clin Endocrinol Metab. 2005;90(1):66-71.
16. Carmina E, Legro RS, Stamets K. Body weight differences in PCOS populations. Hum Reprod. 2003;18(11):2289-93.
17. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Diabetes risk in PCOS. J Clin Endocrinol Metab. 1999;84(1):165-9.
18. Vgontzas AN, Legro RS, Bixler EO. Insulin resistance and sleep apnea in PCOS. J Clin Endocrinol Metab. 2001;86(2):517-20.
19. Hecht Baldauff N, Arslanian S. Management of PCOS in adolescents. Arch Dis Child. 2015;100(11):1076-83.
20. Badawy A, Elnashar A. Treatment options for PCOS. Int J Womens Health. 2011;3:25-35.
21. Hopkinson ZE, Sattar N, Fleming R. PCOS as metabolic syndrome. BMJ. 1998;317:329-32.
22. Holte J, Bergh T, Berne C. Insulin resistance and ovarian function in PCOS. J Clin Endocrinol Metab. 1994;78:1052-8.
23. Ehrmann DA, Barnes RB, Rosenfield RL. Impaired glucose tolerance in PCOS. Diabetes Care. 1999;22:141-6.
24. Moghetti P, Castello R, Negri C. Metformin effects on endocrine and metabolic profiles in PCOS. J Clin Endocrinol Metab. 2000;85:139.
25. Morin-Papunen LC, Vauhkonen I, Koivunen RM. Metformin in obese women with PCOS. J Clin Endocrinol Metab. 2000;85:3161.
26. Pasquali R, Gambineri A, Biscotti D. Long-term metformin in obese PCOS women. J Clin Endocrinol Metab. 2000;85:2767.
27. Harborne LR, Sattar N, Norman JE. Metformin and weight loss in obese PCOS. J Clin Endocrinol Metab. 2005;90:4593.
28. Kiddy DS, Hamilton-Fairley D, Bush A. Dietary treatment and ovarian function in obese PCOS. Clin Endocrinol (Oxf). 1992;36:105-11.
29. Tang T, Glanville J, Hayden CJ. Lifestyle modification and metformin in obese PCOS. Hum Reprod. 2006;21:80-9.
30. Nestler JE. Metformin in PCOS. N Engl J Med. 2008;358:47.
31. Lord JM, Flight IH, Norman RJ. Insulin-sensitizing drugs in PCOS. BMJ. 2003;327:951.
32. Legro RS, Arslanian SA, Ehrmann DA. Endocrine Society guideline on PCOS. J Clin Endocrinol Metab. 2013;98(12):4565-92.
33. Costello M, Shrestha B, Eden J. Insulin sensitizers vs OCPs in PCOS. Cochrane Database Syst Rev. 2007:CD005552.
34. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352:1223-36.
35. Bolumar F, Olsen J, Rebagliato M. Body mass index and delayed conception. Am J Epidemiol. 2000;151:1072-9.
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Published
Aug 20, 2023
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How to Cite
Dr. Saima Shaikh, Dr. Samreen Zeeshan, Dr. Faria, Dr. Hajira Khalid, Dr. Amina Begum, Dr. Nida, & Dr. Amber Shams. (2023). EFFECT OF BODY MASS INDEX ON MENSTRUAL CYCLE REGULATION IN WOMEN WITH POLYCYSTIC OVARY SYNDROME RECEIVING INSULIN-SENSITIZING THERAPY. Journal of Population Therapeutics and Clinical Pharmacology, 30(8), 689-693. https://doi.org/10.53555/bzbghq78
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Author Biographies
Dr. Saima Shaikh
MBBS, Chandka Medical College FCPS, Dow University of Health Sciences
Dr. Samreen Zeeshan
MBBS, FCPS
Dr. Faria
MBBS, Liaquat University of Medical & Health Sciences (LUMHS)
FCPS
Dr. Hajira Khalid
MBBS, Dow Medical College
Dr. Amina Begum
MBBS, Chandka Medical College, Larkana FCPS, Dow University of Health Sciences, Karachi
Dr. Nida
MBBS, FCPS Dow University of Health Sciences
Dr. Amber Shams
MBBS, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro, Pakistan
Professional Diploma in Gynaecology & Obstetrics, Royal College of Physicians of Ireland (RCPI)
ORCID: https://orcid.org/0009-0001-2702-0648
How to Cite
Dr. Saima Shaikh, Dr. Samreen Zeeshan, Dr. Faria, Dr. Hajira Khalid, Dr. Amina Begum, Dr. Nida, & Dr. Amber Shams. (2023). EFFECT OF BODY MASS INDEX ON MENSTRUAL CYCLE REGULATION IN WOMEN WITH POLYCYSTIC OVARY SYNDROME RECEIVING INSULIN-SENSITIZING THERAPY. Journal of Population Therapeutics and Clinical Pharmacology, 30(8), 689-693. https://doi.org/10.53555/bzbghq78
