Date of Award

2021

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

Objective: The objective of this selective EBM review is to determine whether or not “Is metformin an effective adjunct treatment in treating hirsutism in patients with PCOS?”

Study Design: A review of three randomized control trials (RCTs) published in English between 2011-2018.

Data Sources: This paper evaluates three RCTs found via PubMed comparing the efficacy of simvastatin, clomiphene citrate and exercise as monotherapies versus each therapy in combination with metformin for the treatment of hirsutism in women with PCOS.

Outcome(s) Measured: Hirsutism was measured using the Ferriman and Gallwey score. This score measures hirsutism based on the quantity and thickness of terminal hair growth in 9 androgen-sensitive areas, including upper lip, chin, chest, upper and lower abdomen, back and upper arm and thigh.

Results: All three studies found that adjunctive metformin did not offer a statistically significant increase in the reduction of hirsutism when compared to monotherapy treatments. The RCT performed by Banaszewska et al. showed a 1.0 point Ferriman and Gallwey score decrease when treated with simvastatin and metformin combination, which is not a statistically significant reduction when compared to the simvastatin only group, a 1.1 point decrease (p=0.52). The RCT performed by Roth et al. similarly showed a 1.1 point decrease when treated with clomiphene citrate and metformin combination, which is not a statistically significant reduction when compared to the clomiphene citrate only group, a 0.6 point decrease (p=0.44). The RCT performed by Tiwari et al. showed a 1.63 point decrease when treated with exercise and metformin which is also not a statically significant reduction when compared to the exercise only group, a 0.67 point decrease (p=0.567).

Conclusions: All three studies demonstrated that the adjunctive metformin accounted for a decrease from the Ferriman and Gallwey score baselines, however, the decrease from baseline was not significantly different from the monotherapy treatment. Future studies should include adolescent populations, incorporate patient self-assessment data and cover a duration of treatment greater than six months.

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