Background: Metformin is an established treatment of polycystic ovarian syndrome (PCOS) but patient-reported outcomes with respect to its effects and tolerability have not been widely reported. About 68 patients with PCOS treated with metformin in our clinic were surveyed by questionnaire.
a. Demographics: 42/68 patients were currently, and 26 previously treated with metformin for PCOS. Median age and BMI was 31 years (range 1649), and 33.9 (range 20.251.8) respectively. Median duration of PCOS was 4 years and 5 months. Median metformin dose and duration of treatment was 1.5g daily, and 12 months respectively. About 22 patients stopped metformin at some point due to side effects (predominantly gastrointestinal), and 8 due to insufficient improvement on metformin. Eight patients changed from metformin to glucophage SR.
b. Response to metformin: 28/68 (41%) reported improvement in menstrual regularity. About 33/68 (49%) reported no change, and 17/68 (25%) improvement in heaviness of period. About 28/68 reported difficulty conceiving. Of these 4 conceived on metformin alone and 1 on metformin and clomiphene. About 26/68 patients reported acne, of which half reported improvement with metformin. About 16/68 (24%) patients reported improved hirsuitism. About 27/68 (40%) patients reported a median weight loss of 4.5kg with metformin. Of those on metformin for at least 6 months, 22/46 (48%) reported median weight loss of 5kg. About 41/68 (60%) patients treated with metformin were happy to continue treatment on it.
Conclusions: A large minority of patients report improvement in menstrual regularity and/or heaviness with metformin, and a significant minority report an improvement in acne and in hirsutism (not reported in many previous studies but consistent with recent meta-analyses). Metformin was associated with significant weight loss in a substantial minority of patients. This report shows that metformin is perceived favourably by patients with respect to its role in treating menstrual disturbance, hirsuitism, acne and obesity associated with PCOS.