Women with polycystic ovary syndrome often take metformin to help manage their condition. A large review looked at fifty-one clinical trials to see how this drug affects specific hormones in the body. The researchers found that metformin treatment did not change the levels of FSH or LH. These are two hormones that help control the menstrual cycle and egg development. However, the drug did make a clear difference in the ratio between these two hormones. The LH to FSH ratio went up significantly for the women taking the medication. This specific change might be important for fertility or cycle regulation, even if the individual hormone levels stayed the same. The study combined data from many different trials to get a clear picture of what happens across a large group of patients. Safety issues were not reported in the data provided for this review. The findings rely on the results from these fifty-one trials, and the effect size was sensitive to one specific study in the analysis. This means the results could shift if that single trial were excluded. Still, the main takeaway is that metformin has a distinct effect on the balance between these two hormones.
Metformin shows limited impact on gonadotropin levels in PCOS womenMetformin changes one hormone ratio but leaves others unchanged in PCOS
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Key Takeaway
Metformin does not change FSH or LH but significantly increases the LH/FSH ratio in PCOS women.
A systematic review and meta-analysis of 51 randomized controlled trials evaluated the effects of metformin on gonadotropin levels in women with polycystic ovary syndrome (PCOS). The primary outcomes were follicle-stimulating hormone (FSH), luteinizing hormone (LH), and the LH/FSH ratio. The analysis found that metformin treatment did not significantly affect FSH levels, with a weighted mean difference of -0.22 IU/L (95% CI: -0.54 to 0.11, p=0.19). Similarly, LH levels were unchanged, with a WMD of 0.11 IU/L (95% CI: -0.38 to 0.60, p=0.66).
However, the LH/FSH ratio showed a significant increase with metformin, with a WMD of 0.24% (95% CI: 0.06 to 0.43, p=0.01). This suggests a specific hormonal shift rather than broad gonadotropin suppression. Safety data were not reported in the included studies, limiting conclusions on tolerability.
A key limitation is that the effect size for all outcomes was sensitive to one study in sensitivity analyses, indicating potential fragility in the results. The findings highlight that metformin's primary benefit in PCOS may not be through direct modulation of FSH or LH, but through altering their ratio, which could influence ovulatory function.
What this means for you:
Metformin increases the LH to FSH ratio but does not change FSH or LH levels in PCOS. More on Polycystic Ovary Syndrome
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View Original Abstract ↓
AIMS: This study aimed to explore the impact of metformin on gonadotropin levels in women with polycystic ovary syndrome (PCOS) based on a meta-analysis of randomised controlled trials (RCTs).
METHODS: The search process was performed in PubMed, Scopus, Web of Science, ClinicalTrials.gov and Google Scholar. RCTs were eligible for meta-analysis if they had a parallel or crossover design and reported gonadotropin levels before and after metformin treatment. A random-effects model and the generic inverse variance method were used for meta-analysis.
RESULTS: The meta-analysis of 51 RCTs, 48 of which included only and 2 included predominantly women with PCOS, showed that metformin treatment did not affect FSH (WMD: -0.22 IU/L, 95% CI: -0.54, 0.11, p = 0.19, I = 84%) or LH (WMD: 0.11 IU/L, 95% CI: -0.38, 0.60, p = 0.66, I = 75%), but it significantly increased the LH/FSH ratio (WMD: 0.24%, 95% CI: 0.06, 0.43, p = 0.01, I = 93%). Additionally, the effect size was sensitive to one study for FSH, LH and LH/FSH ratio following the sensitivity analysis.
CONCLUSION: Our meta-analysis, the largest one conducted to date, indicates that metformin does not significantly affect circulating gonadotropin levels in reproductive-age women with PCOS.
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