What’s New With PCOS?

POLYCYSTIC OVARY SYNDROME (PCOS) is a cluster of symptoms in women caused by hormonal imbalances. Symptoms may include missed or irregular menstrual periods, painful periods, infertility, excess facial hair (hirsuitism), and being overweight.

It’s also common for women with PCOS to be insulin resistant. This insulin resistance can cause the ovaries to produce excess male hormones, which in turn can cause infertility. Women with diabetes (both type 1 and type 2) seem prone to PCOS; by some estimates, a quarter of women with diabetes have PCOS.

Several recent studies have shed light on the condition and treatment options for women who suffer from it.

Lifestyle Therapy More Difficult Than Previously Thought

Weight loss-a standard part of PCOS treatment-may actually be particularly challenging for women with PCOS. A study in the International Journal of Obesity in August 2004 focused on the diet and exercise habits of 84 women with PCOS and 79 women who did not have the condition. The habits were the same for both groups, although more of the women with PCOS were overweight, suggesting that women with PCOS are not overweight because they eat more or exercise less than other women. Among those women who had normal weights, those with PCOS ate significantly fewer calories a day.

The researchers said the results suggest that women with PCOS are predisposed to obesity.

Drug Therapy

Early PCOS drugs, such as clomiphene (Clomid), reduced production of male hormones or stimulated ovulation. Clomiphene is still commonly used today, but it doesn’t work in everyone.

A newer approach is to prescribe an agent that boosts insulin sensitivity. The diabetes drug metformin (Glucophage) has been studied the most in this regard. But researchers are finding evidence that PCOS responds also to other insulin-sensitizing drugs as well:

* Some women with PCOS do not ovulate regularly, and pioglitazone (Actos) may encourage ovulation. In a 3-month study of 35 women, half of whom took pioglitazone, 41.2 percent of the pioglitazone group had signs of ovulation, versus only 5.6 percent of the other group (Journal of Clinical Endocrinology and Metabolism [JCEM], August 2004).

* Not all women with PCOS are insulin resistant, and one study has found that insulin sensitizers may help those women as well. In a study of 100 nonobese women between the ages of 17 and 40 who did not have insulin resistance, the subjects took metformin, rosiglitazone (Avandia), both, or neither. After 6 months, everyone in the metformin and combination groups had ovulated, versus 91 percent of the rosiglitazone group and 37 percent of those who were not on drug therapy (JCEM, October 2004).

Heart Risks

Women with PCOS have more risk factors for heart and blood vessel disease than other women.

Two 2004 studies in JCEM, one in August and one in September, found that heart damage among women with PCOS starts early, making early diagnosis and treatment vital.

So see your doctor if you have symptoms of PCOS. Early diagnosis and treatment can help not only a woman’s fertility but also her heart health.

Avandamet Shortage

In March, the U.S. Food and Drug Administration (FDA) halted GlaxoSmithKline’s production and distribution of the type 2 drug Avandamet after finding that some tablets had slightly elevated levels of the ingredient rosiglitazone maleate.

The FDA blamed the problem on deficiencies in the manufacturing process, and as Diabetes Forecast went to press, they had not been resolved. As a result, many pharmacies were experiencing shortages of the drug.

According to both the FDA and GlaxoSmithKline, it’s okay to finish taking any remaining Avandamet you may have. However, you should talk to your doctor about other treatment options during the shortage.

The two active ingredients in Avandamet-rosiglitazone maleate and metformin-are available separately. Rosiglitazone maleate is available as Avandia, also by GlaxoSmithKline. Metformin is available as Glucophage and extended-release Glucophage XR, both manufactured by Bristol-Myers Squibb Company. Regular metformin (not extended-release) is available as a generic, as well.

“We think we’ve found the manufacturing issue, and we’ve implemented processes to take care of that,” says Nancy Pekarek, spokesperson for GlaxoSmithKline. “But we’ll need FDA approval before we can resume production and put [Avandamet] back out on the market.”

-Terri Kordella

Shauna S. Roberts, PhD, is a science writer in New Orleans, La.

Copyright American Diabetes Association Jul 2005