Metformin and the Polycystic Ovary Syndrome
Abstract
Moghetti et al. (1) are to be congratulated for their marvelous study assessing the effects of long-term metformin treatment in women with polycystic ovary syndrome (PCOS). The investigators used a metformin dose of 500 mg t.i.d. (1500 mg daily). It is possible that women who did not respond to metformin at this dose might have responded had the dose been increased to 1000 mg b.i.d. (2000 mg daily). A dose-response study in type 2 diabetic patients has shown that a daily metformin dose of 1500 mg was less effective than 2000 mg, and that 2000 mg daily is the optimal dose (2). Presumably, 2000 mg daily is the dose that maximally improves hepatic and muscle insulin sensitivity. We have used a metformin dose of 500 mg t.i.d. in all our published studies in PCOS by historical accident (3–5). Metformin was not available in the United States at the time of our first study (3), and in Europe it was being dosed in this fashion. We maintained this dose in subsequent studies for consistency and to do comparative analyses in the future.
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