Table 2 Pros and cons of insulin sensitizer therapy in PCOS

Reduces insulin resistance and addresses an important component of the pathophysiology of PCOS

Useful for treating hyperglycemia in patients with PCOS-associated type 2 DM

Insulin-sensitizing effect may not persist after discontinuing medication

Metformin may cause weight reduction and is associated with improvement in lipid profile

Weight reduction is minor with metformin; TZDs may cause weight gain and peripheral lipogenesis

Cosmetic improvements with insulin sensitizers may be less marked than with E₂-P combination pills

Insulin sensitizers may induce ovulation with risk of unwanted pregnancy unless used with contraception

An option in patients with Factor V Leiden mutations and other risk factors for coagulopathy in whom E₂-P combination pills may be contraindicated

Potential for use in adolescents with lean PCOS in whom lifestyle modification is likely to be ineffective

Lean PCOS responds well to conventional E₂-P combination pills in conjunction with anti-androgen medications

Excellent safety profile for metformin, with few side effects reported

Insulin sensitizers are potential teratogens Select patients may require frequent monitoring of liver and renal function TZDs have been associated with adverse cardiovascular events in adult patients

Insufficient studies of efficacy and long term safety of insulin sensitizers in adolescents