Impact of Metformin Therapy on Inflammatory Markers and Insulin Resistance in Women with Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder among women of reproductive age, affecting 8-13% of this population based on different diagnostic criteria. Its underlying mechanisms are associated with insulin resistance and chronic inflammation. This study investigates the serum levels of fractalkine and high-sensitivity C-reactive protein (hs-CRP), both indicators of chronic inflammation, in PCOS patients before and after treatment with metformin.

The study included 30 women with PCOS were recruited from gynecology and dermatology outpatient departments. Serum levels of fractalkine and hs-CRP were assessed prior to starting metformin therapy. Patients received metformin, starting with 500 mg once daily and gradually increasing to 500 mg three times daily over a four-month period, after which serum levels of fractalkine and hs-CRP were measured again.

The results revealed:

After metformin treatment, there was a significant decrease in serum fractalkine levels (from 0.52 ± 0.29 to 0.38 ± 0.21 ng/ml).
hs-CRP levels also showed a significant reduction (from 0.71 ± 0.37 to 0.58 ± 0.27 ng/ml).
Additionally, clinical improvements were observed in hirsutism, acne, acanthosis, and body mass index (BMI), along with a notable reduction in insulin resistance indicators.

In conclusion, chronic inflammation in PCOS is a contributing factor to insulin resistance. Metformin therapy appears to enhance insulin sensitivity, which in turn reduces hyperinsulinemia and hyperglycemia, causing decreased production of reactive oxygen species and improvement in chronic inflammation. This is supported by the observed decreases in serum fractalkine and hs-CRP levels, as well as improved insulin resistance parameters in the study.

Source: Kumari R, Singh A, Banerjee BD et al. Impact of Metformin Therapy on Chronic Inflammatory Markers Serum Fractalkine and CRP Levels in Polycystic Ovary Syndrome: A Pilot Study on Chronic Inflammatory Markers and Clinical Outcomes. J Obstet Gynecol India (2025). https://doi.org/10.1007/s13224-025-02100-0

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