Role of Metformin in PCO

metformin  inhibits  hepatic   gluconeogenesis  through  an AMP   activated protein    kinase   dependent regulation  of the orphan  nuclear    receptor   small heterodimer partner.

  Point 10: Lastly, to conclude, out of so  many about 6 kinds of insulin sensitizers or blood glucose lowering agents why metformin is considered as safest ,more so in rural settings?? Ans:- actions of metformin are nor  associated with an increase  in insulin secretion and consequently   with hypoglycemia.

 Q. 11: What is the beneficial effects on ovary ?? Ans:-Metformin affects ovarian   function    in a dual way 1) alleviation of systemic  insulin   excess acting  upon the ovary   particularly   on steroidogenesis  and follicular    growth 2) direct  ovarian   effect. 3) Modulates LHaction:-   metformin acts at the hypothalamic levels  on AMPK   pathway the latter  is essential in the modulation of LH  secretion 4) Effects on androstenedione:-studies   demonstrated  that metformin  inhibits  androstenedione    and testosterone    production form theca  cells through inhibition  of  the steroidogenic    acute regulatory    protein   and 17 a hydroxylase  expression. 5) Metformin reduces  FSH      without     altering   cAMP  levels

  Point 12: What do a PCO woman is benefitted by decrease of serum FSH? How it helps at granulosa cell level?? Ans: The indirect   role of metformin on granulosa cells by decreseing IGF-1 . This is very impotrtnat and most important opath, at least I feel in that way that IGF-1 is notorious to cause & propagate PCO. Metformin , at the ovarian   level with its    hyperandrogenic intra follicular    pattern  cause improved function  by a   decrease   in IGF-1   availability  that has an important  role in  controlling  granulosa   cell aromatase   levels.

Point 13: PCOS have higher   levels of FSH  receptor    expression  compared with those   from normal   ovaries .Ans:-

It has been shown that granulosa cells from women with metformin reduces  FSH      without     altering   cAMP  levels.  This involves blocking activation    of CRE  on promoter  ii of CYP19   via inhibition of pCREB   and possible    disruption  of the formation of the CREB – CRTC  2  co activator complex.  This is   via an  AMPK  independent    mechanism . 

Metformin   is available as 500, 850 and 1,000 mg  tablets with a target   dose of  1,500-2,550 mg / day Dosage  and side  effects

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