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Experts Corner

Women's Health

Insulin Altering Drugs
By Samuel Thatcher, MD, Ph.D.

Sam Thatcher, MD, Ph.D.Q. What is the current thinking on the best treatment of PCOS? The doctors I have seen always recommend either birth control pills or Clomid (if I want to get pregnant). It seems like there must be something new out there!

A. At least 50% of PCOS appears to have a component of abnormal glucose tolerance, increased insulin or insulin resistance. In part by accident, it was stumbled on that insulin-altering drugs generally used in the treatment of diabetes were successful in regulating periods, promoting ovulation and increasing fertility. These drugs have not received FDA approval for this use, but have become widely employed. We now have a therapy that actually treats the cause of PCOS rather than just overpowering or suppressing it. The principle first line therapy is metformin (Glucophage) which often has the benefit of weight loss, but has GI side-effects. The second group of drugs include Actos and Avandia and directly reduce insulin. The success of these agents seems to be at least as good as clomiphene and sometimes work when all else fails. Still, they are not perfect and should be discussed in detail with your physician, and best used after appropriate lab testing.

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