Publication:

Comparison between the effects of low-dose spironolactone plus metformin and metformin alone on hormonal and biochemical parameters of insulin resistance in women with polycystic ovary syndrome

Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-age women, characterized by insulin resistance and hyperandrogenism. Metformin improves insulin sensitivity, while spironolactone has antiandrogenic effects. Evidence regarding the short-term benefit of combining low-dose spironolactone with metformin remains inconclusive, particularly in South Asian populations. This study aimed to compare the effects of low-dose spironolactone plus metformin versus metformin alone on hormonal and biochemical parameters of insulin resistance in women with PCOS.

Methods This randomized controlled trial was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2023 to June 2024. Ninety women aged 18-40 years with PCOS (Rotterdam criteria), BMI 18-30 kg/m2, and HOMA-IR>2 were randomized to receive either spironolactone (50 mg/day) plus metformin (1500 mg/day) or metformin alone (1500 mg/day) for 12 weeks. Hormonal and metabolic parameters were measured at baseline and post-treatment.

Results Both groups showed significant improvements in BMI, waist circumference, serum LH, FSH, LH/FSH ratio, free testosterone, fasting glucose, fasting insulin, and HOMA-IR (p 0.05).

Conclusions Both low-dose spironolactone plus metformin and metformin alone significantly improve hormonal and insulin resistance parameters in women with PCOS. However, the addition of spironolactone does not provide a significant short-term advantage over metformin alone.