Re: Brand new abstract on PCOS--folloup to my last comment

[Guest guest]

Thanks for sharing this abstract! I am leading a journal club next week for 3rd

year family medicine residents re: PCOS and this article is incredibly timely.

Judy D. Simon MS, RD, CD, CHES

Clinic Dietitian/Nutritionist

University of Washington Medical Center-Roosevelt Campus

Campus mail: box 354700

4245 Roosevelt Way NE

Seattle, WA 98105-6902

Brand new abstract on PCOS--folloup to my last comment

Colleagues,

I withheld opinion in my last post, but here's an article that supports my

viewpoint. This comes from a very prominent researcher at the University of

Chicago. I actually had a client I referred to a repro endo practice here be

told by the receptionist when she made her appointment that she would be given

metformin. It made her so nauseous she couldn't eat, and she was told to just

hang in there, everyone feels that way for 3 months. It has its benefits, but it

shouldn't be handed out like candy as some kind of miracle cure-all.

One big reason why I'm so devoted to sharing nutritional options that not only

improve conception...but which keep insulin function healthy during pregnancy,

minimize postpartum depression, and improve the ability to breastfeed afterward.

We just have to know our stuff inside out and brag about it!

Monika M. Woolsey, MS, RD

http://www.afterthediet.com

http://www.incyst.blogspot.com

http://www.thisisyourbrainonpsychdrugs.blogspot.com

Nat Clin Pract Endocrinol Metab. 2008 May;4(5):272-83. Epub 2008 Mar 25. Links

Drug insight: insulin-sensitizing drugs in the treatment of polycystic ovary

syndrome--a reappraisal. Dunaif A; Medscape.

Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School

of Medicine, Northwestern University, 303 E Chicago Avenue, Tarry 15-709,

Chicago, IL 60611, USA. a-dunaif@...

The recognition that insulin resistance has a pivotal role in the pathogenesis

of polycystic ovary syndrome (PCOS) revolutionized our understanding of this

complex disorder. PCOS causes major metabolic and reproductive morbidities,

including substantially increased risk for type 2 diabetes mellitus and the

metabolic syndrome. Insulin-sensitizing drugs (ISDs) ameliorate reproductive

abnormalities, restore ovulation and regular menses, increase pregnancy rates

and reduce androgenic symptoms in affected women with PCOS. Accordingly, ISDs,

specifically metformin, have been widely adopted as therapy for this condition.

A recent, large, randomized, multicenter, clinical trial that assessed

live-birth rates rather than surrogate end points suggested that metformin alone

is inferior to clomiphene citrate in treating infertility associated with PCOS.

There is, furthermore, no evidence to support the use of metformin during

pregnancy to prevent spontaneous abortions or gestational diabetes mellitus in

women with PCOS. Renewed safety concerns about thiazolidinediones followed

recent studies that reported increased cardiovascular morbidity with these

agents. These concerns might preclude thiazolidinedione use in otherwise healthy

women with PCOS. Finally, although ISDs improve insulin action and

cardiovascular disease risk, there is no evidence that they provide long-term

health benefits in PCOS. This article discusses the role of ISDs in PCOS in

light of these new data.