Oner, G., & Müderris, I. I. (2011). Clinical, endocrine and metabolic effects of metformin vs N-acetyl-cysteine in women with polycystic ovary syndrome. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 159(1), 127-131. https://doi.org/10.1016/j.ejogrb.2011.07.005
Oner G, Müderris II. Clinical, endocrine and metabolic effects of metformin vs N-acetyl-cysteine in women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2011;159(1):127-131. doi:10.1016/j.ejogrb.2011.07.005
Oner, Gokalp, and Iptisam Ipek Müderris. "Clinical, endocrine and metabolic effects of metformin vs N-acetyl-cysteine in women with polycystic ovary syndrome." European Journal of Obstetrics, Gynecology, and Reproductive Biology, vol. 159, no. 1, 2011, pp. 127-131.
Metformin and NAC Appeared Comparable for PCOS Hirsutism and Cycles
Metformin and N-acetyl-cysteine (NAC) both lowered hirsutism scores and improved cycle regularity. The difference between them was not significant. This 2011 randomized trial enrolled 100 women with polycystic ovary syndrome (PCOS, now called PMOS). Treatment lasted 24 weeks and 75 women finished.
Key Findings
Seventy-five of the 100 women finished: 30 on metformin and 45 on NAC.
Ferriman-Gallwey hirsutism scores fell from 11.4 to 6.9 with metformin and from 12.0 to 7.7 with NAC. The groups did not differ significantly.
Menstrual regularity rose from 17% to 47% of women on metformin and from 29% to 53% of women on NAC.
Total cholesterol fell in both groups. LDL cholesterol fell significantly only with NAC, and lipid profiles did not differ significantly between the groups.
TNF-α levels rose in both groups after treatment, but the change from baseline was not significant.
Interpretation
This randomized trial compared metformin and NAC head-to-head over 24 weeks in women with PCOS-related hirsutism and menstrual irregularity. The 75 women who finished averaged 23.2 years of age (range 17 to 38). The authors note the dropout in the metformin group as a limitation; two women stopped because of gastrointestinal side effects. The findings support larger trials of insulin-sensitizing treatment in PCOS.
RRM Context
The authors say most PCOS care only manages symptoms. They see drugs like metformin as aimed at a root cause. Restorative reproductive medicine asks the same question: what drives the irregular cycles and extra hair growth. This trial tracked cycle regularity and hirsutism scores, both signs of that root cause.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To evaluate the clinical, endocrine and metabolic effects of metformin and N-acetyl-cysteine (NAC) in patients with polycystic ovary syndrome (PCOS).
Study Design
In this prospective trial, 100 women with PCOS were randomly divided to receive metformin (500 mg p.o. three times daily) or NAC (600 mg p.o. three times daily) for 24 weeks. Hyperandrogenism, lipid profiles, hirsutism scores, menstrual irregularity, insulin sensitivity and tumour necrosis factor-α (TNF-α) levels were measured at baseline and after the treatment period.
Results
Both treatments resulted in a significant decrease in body mass index, hirsutism score, fasting insulin, HOMA index, free testosterone and menstrual irregularity compared with baseline values, and both treatments had equal efficacy. NAC led to a significant decrease in both total cholesterol and low-density lipoprotein levels, whereas metformin only led to a decrease in total cholesterol level. Although TNF-α levels increased following treatment for both groups, the difference from baseline was not significant.
Conclusions
Metformin and NAC appear to have comparable effects on hyperandrogenism, hyperinsulinaemia and menstrual irregularity in women with PCOS. The effects of metformin and NAC on insulin sensitivity are not associated with TNF-α.
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