Just to let you know that my father has spotted this article whilst he was reading in the health section of "The Times" newspaper last Thursday and he thought that I'd like to read it.
I found that this one was quite interesting, it's about PCOS and Metformin and I have attached the link for you to read, if you like to.
Old drug: new hope
By Barbara Rowlands
A chance discovery may be the key to alleviating polycystic ovary syndrome
FOR TEN YEARS Sarah Hearne lived with the misery of acne, depression, anxiety and excess pounds. Despite being 5ft 3in (1.6m), her weight rose to 12st (76kg). “I felt so lethargic. Even though the doctors told me I was depressed, at the back of my mind I knew it wasn’t just depression,” she says.
Sarah, 33, was finally sent to an endocrinologist, who diagnosed polycystic ovary syndrome (PCOS). First she was prescribed an oral contraceptive, but this gave her migraine, and spironolactone — a diuretic and antiandrogen drug — which made her faint.
Five months ago her consultant prescribed Metformin. “Within a week I felt much better and my skin cleared up almost miraculously,” she says. “I’m now 8st instead of 12st, and my periods are regular.” The facial hair she had developed has become “much finer”, and “I have more energy and I’m much happier. I’m getting married this year.”
But Metformin is hardly a new wonder drug. It has been around for 25 years and is used for the treatment of late-onset or Type 2 diabetes. As with Viagra — which was originally used to treat coronary heart disease — Metformin’s new application was discovered by chance when researchers realised that it alleviated the symptoms of PCOS.
PCOS is the most common hormonal disturbance among women. Among the well-known sufferers is the actress Emma Thompson, the mother of three-and-half-year-old Gaia. She spoke this week about the “agony” of not being able to have any more children.
“There’s been an awful lot of grief to get through in not being able to get pregnant again, but there are thousands and thousands of women like me who can’t have children,” she says. “For me not being able to have another child really, really hurts.”
The syndrome manifests itself in a range of symptoms for which there are myriad treatments. These treatments were discussed at a recent international conference of PCOS specialists in Rotterdam. Among the speakers were Adam Balen, a consultant in reproductive medicine at Leeds General Infirmary, who is conducting the world’s largest randomised, placebo-controlled trial on Metformin, and Stephen Franks, professor of reproductive endocrinology at St Mary’s and Hammersmith hospitals and one of Britain’s leading endocrinologists.
The key to PCOS, and the success of Metformin, lies with insulin. Most women with PCOS have an abnormal insulin response: this means food is turned into fat instead of being converted into energy in the muscle. To overcome this the body produces more insulin, and it is this excess insulin which causes the ovary to misbehave and produce testosterone, which in turn inhibits the development of the egg follicles and causes excessive hair growth.
Metformin works by cutting the production of insulin, so improving ovarian function and regularising menstruation. As Balen says, it gets to the heart of the problem.
But as Metformin is not the standard treatment for PCOS, many GPs are reluctant to prescribe it. Even consultants are wary of a drug that is not backed up by a large number of placebo-controlled clinical trials. Franks says he is “quite positive about it, and does prescribe it”, although he admits that “the amount of hard data about the efficacy of Metformin is not terribly impressive”, pointing out that there have been only a few randomised controlled trials, and that those have not been very large.
The result is that many women with PCOS are prescribed the Pill, which can mask the symptoms by shutting down the reproductive cycle, thus depriving the body of the hormones that cause hirsutism and acne. Dr Gerard Conway, a consultant endocrinologist at University College London and Middlesex Hospital, believes that tens of thousands of women would benefit by switching to Metformin. Dr Andrew Watson, a consultant gynaecologist at Tameside Hospital in Ashton, near Manchester, agrees. “There are women who are not on the right drugs and who could be helped by Metformin. I’ve treated 200 patients, and while a good 10 to 20 per cent give up, for the bulk of patients it works well — and it’s cheap.”
Metformin tends to be given to women who are overweight and have problems losing it. For many it works successfully, especially when combined with diet and exercise. Jo Woodhead, 36, began taking Metformin last August. She weighed 20st and has lost 6½st. She says that she has become “less snappy”, has rediscovered her sex drive and for the first time in her life has a normal menstrual cycle.
But Metformin does have side-effects — nausea, flatulence and diarrhoea — which can prove too much for some women.
Balen is now running a trial to build up data on the drug and to find out if it works on all women or just those who are overweight. He believes that the published studies show good evidence that the drug improves metabolism and has a beneficial effect on the ovaries, so enhancing ovulation and giving a more regular menstrual cycle. It may even improve hirsutism.
But while he prefers to wait for the results of his study and future research, others are eager to prescribe Metformin now to help women such as Sarah, for whom nothing else worked. “How long should you wait for the evidence to come out when you see dramatic improvements?” Watson asks. “Should I be treating patients knowing that Metformin usually works or should I ask them to come back in five years when I have the evidence to show them it works? If insulin is the core part of the issue then we are treating the core problem.”
The symptoms and treatment of PCOS
POLYCYSTIC ovaries are common, and a tendency to develop them is inherited. Between 20 and 30 per cent of women have polycystic ovaries, and half of all South Asian women have the condition.
At birth each ovary contains thousands of egg follicles. After puberty, one grows into a ripe egg every month. The immature follicles, about 2mm to 8mm long, remain in the ovary and wither away. But in women with polycystic ovaries as many as ten follicles start to grow each month, but often fail to ripen fully.
Seventy-five per cent of women with polycystic ovaries will have polycystic ovary syndrome — a mix of polycystic ovaries and abnormal hormone levels, including raised levels of testosterone, oestrogen and insulin. This mix prevents women from ovulating, or ovulating regularly, and follicles rarely, if ever, develop into an egg.
Women with PCOS can suffer irregular periods (or lack of them), oily skin, acne, excess hair growth and weight gain. Infertility is the most serious symptom. They also have higher blood pressure and cholesterol levels and are seven times more likely to have a heart attack than other women. They are at higher risk of endometrial cancer, and have twice the risk of developing Type 2 diabetes.
Treatment depends on the symptoms. Many younger women are given the contraceptive pill, which regularises periods and contains antiandrogens to fight hirsutism.
Women who have trouble conceiving can be treated with clomiphene citrate (Clomid), a fertility drug that induces ovulation. Some need daily hormone injections or keyhole surgery to cauterise the ovaries. This induces ovulation in eight out of ten women.
The Times article - Old drug: New hope 
