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Table 2 Pros and cons of insulin sensitizer therapy in PCOS

From: State of the Art Review: Emerging Therapies: The Use of Insulin Sensitizers in the Treatment of Adolescents with Polycystic Ovary Syndrome (PCOS)

PROS CONS
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