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Comparison of Efficacy of Spironolactone with Metformin in the Management of Polycystic Ovary Syndrome: An Open-Labeled Study

Departments of Endocrinology and Metabolism (M.A.G., M.L.K., M.E., A.C.A.), Radiology (M.G.), and Biostatistics (S.N.D.), All India Institute of Medical Sciences, New Delhi 110029, India

Address all correspondence and requests for reprints to: Dr. A. C. Ammini, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. E-mail: aca433{at}yahoo.com.

We compared the efficacy of spironolactone (50 mg/d) with metformin (1000 mg/d) after random allocation in 82 adolescent and young women with polycystic ovary syndrome (PCOS) on body mass index (BMI), waist-to-hip ratio, blood pressure, menstrual cyclicity, hirsutism, hormonal levels, glycemia, and insulin sensitivity at baseline and at the 3rd and 6th months of treatment. Sixty-nine women who completed the follow-up had a mean age of 22.6 ± 5.0 yr and mean BMI of 26.8 ± 4.0 kg/m². The number of menstrual cycles in the spironolactone and metformin groups increased from 6.6 ± 2.1 and 5.7 ± 2.3 at baseline to 9.0 ± 1.9 and 7.4 ± 2.6 at 3rd month and to 10.2 ± 1.9 and 9.1 ± 2.0/ year at the 6th month (P = 0.0037), respectively. The hirsutism score decreased from 12.9 ± 3.2 and 12.5 ± 4.9 at baseline to 10.1 ± 3.1 and 11.4 ± 4.1 at the 3rd month and to 8.7 ± 1.9 and 10.0 ± 3.3 at the 6th month, respectively. Both groups showed improvement in glucose tolerance and insulin sensitivity, although the metformin effect was significant in the latter. Serum LH/FSH and testosterone decreased in both groups. BMI, waist-to-hip ratio, and blood pressure did not change with either drug. We conclude that both drugs are effective in the management of PCOS. Spironolactone appears better than metformin in the treatment of hirsutism, menstrual cycle frequency, and hormonal derangements and is associated with fewer adverse events.

Abbreviations: AUC-I, Area under the curve for insulin; BMI, body mass index; BP, blood pressure; DHEAS, dehydroepiandrosterone sulfate; FGIR, fasting glucose/insulin ratio; HOMA, homeostasis model assessment; IGT, impaired glucose tolerance; OGTT, oral glucose tolerance test; PCOS, polycystic ovary syndrome; PRL, prolactin; WHR, waist-to-hip ratio.

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