Publication:

Effect of metformin plus statin combination therapy compared to metformin alone in infertile woman with symptomatic endometrioma

Background Endometriosis is an estrogen-dependent inflammatory condition characterized by endometrial tissue growth outside the uterus. Metformin suppresses estrogen production and has anti-inflammatory, anti-proliferative, and anti-angiogenic effects. Statins inhibit cholesterol synthesis and offer anti-inflammatory actions, reducing angiogenesis, invasion, adhesion, and lowering MCP-1 and MMP-3 levels. This study compares metformin plus statin versus metformin alone in infertile women with symptomatic endometrioma.

Methods A randomized controlled trial was conducted in the department of reproductive endocrinology and infertility, BSMMU. Forty women with symptomatic endometrioma diagnosed via transvaginal ultrasound (TVS) were randomized into two groups. The experimental group received metformin 500 mg thrice daily plus atorvastatin 40 mg once daily; the control group received only metformin. Treatment lasted 3 months. Outcomes-endometrioma size (TVS), pain [visual analog scale (VAS)], and complement C3 level (Nephelometry)-were measured pre-and post-treatment. Data were analyzed using SPSS v.26.

Results After treatment, the experimental group showed significant reductions in endometrioma size (3.50±0.82 vs 2.41±0.52 cm) and pain score (6.80±1.67 vs 3.13±2.32) from baseline (p<0.05). The control group showed significant reductions in endometrioma size (3.40±0.96 vs 2.92±0.80 cm) and pain score (6.65±2.10 vs 3.47±2.09) from baseline (p<0.05). Serum complements levels increased in both groups insignificantly. Endometrioma size reduction was significantly higher in the experimental group (1.06±0.53 vs 0.45±0.44 cm), but pain score and complement level reductions showed no significant difference between groups.

Conclusions Metformin plus statin shows significantly better reduction in endometrioma size compared to Metformin alone in treating symptomatic endometrioma in infertile women.