Polycystic ovary syndrome (PCOS) was clinically characterised in 1935 based primarily upon its reproductive manifestations of menstrual irregularity and infertility, although hirsutism and obesity were also noted in this small cohort of women [1]. Over the ensuing decades, it became clear that this ‘reproductive’ syndrome was often accompanied by metabolic features that are a consequence of insulin resistance and hyperinsulinaemia [2, 3, 4], for example, impairment in oral glucose tolerance, type 2 diabetes [5, 6], the metabolic syndrome [7, 8] and dyslipidaemia [9, 10]. The magnitude of insulin resistance in PCOS is greater than that caused by excess adiposity alone; it is characterised by reduced sensitivity and responsiveness to insulin-mediated glucose utilisation, primarily in the skeletal muscle, adipose tissue and in the liver [11]. Insulin resistance and resultant hyperinsulinaemia contribute to hyperandrogenaemia in PCOS by augmenting luteinising hormone-stimulated androgen production by ovarian theca cells [12, 13, 14] and by inhibiting hepatic synthesis of sex hormone-binding globulin (SHBG), the latter leading to an increase in bioavailable testosterone [15]. Weight loss or pharmacologic interventions that lower insulin levels have been shown to significantly reduce androgen levels in many women with PCOS [14].
In the 1990s, metformin was shown to ameliorate hyperandrogenism in both obese and non-obese women with PCOS. This effect was attributed to a reduction in hyperinsulinaemia because of enhanced insulin sensitivity [16, 17]. Since these initial reports, there have been over 1000 original publications that have examined the effects of metformin in women with PCOS. Indeed, metformin is now among the most commonly prescribed medications in women with PCOS despite the fact that its use in this population is not approved by the Food and Drug Administration (FDA).
Rena Activation Energy Serum Review
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Rena Activation Energy Serum
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Rena Activation Energy Serum Reviews
Serum levels of zinc, calcium, and iron are associated with the risk of preeclampsia in pregnant women Jihye Kim, Young Ju Kim, Rena Lee, Jong Hwa Moon, Inho Jo Pages 764-769.
Although the mechanisms of metformin action are not well defined and the indications for its use are not clearly established, it appears that the salutary reproductive and metabolic effects of metformin in PCOS are both direct and indirect. This review provides an updated overview of metformin use in PCOS, encompassing our current understanding of its mechanisms of action.