Document Type


Original Publication Date


Journal/Book/Conference Title

New England Journal of Medicine





First Page


Last Page


DOI of Original Publication



Originally published at

Date of Submission

January 2015


This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author’s clinical recommendations.

A 23-year-old woman with known polycystic ovary syndrome visits her family physician. She has taken oral contraceptive pills in the past but did not tolerate them and is not currently receiving any treatment. She has three or four menstrual periods per year and is not interested in becoming pregnant now, but she will be getting married in a year. She has heard that the polycystic ovary syndrome is associated with diabetes and is concerned because both her mother and father have type 2 diabetes. Her bodymass index (the weight in kilograms divided by the square of the height in meters) is 32, her waist circumference is 38 in. (96.5 cm), her serum total testosterone level is elevated at 0.9 ng per milliliter (90 ng per deciliter, or 2.9 nmol per liter), her plasma high-density lipoprotein cholesterol level is 35 mg per deciliter (0.9 mmol per liter), and her triglyceride level is 190 mg per deciliter (2.1 mmol per liter). Her serum glucose level 2 hours after the ingestion of 75 g of dextrose is 138 mg per deciliter (7.7 mmol per liter). The physician wonders whether treatment with metformin would be beneficial and refers the patient to an endocrinologist.


From The New England Journal of Medicine, Nestler, John E., Metformin for the Treatment of the Polycystic Ovary Syndrome, Vol. 358, page 47, Copyright © 2008 Massachusetts Medical Society. Reprinted with permission.

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VCU Internal Medicine Publications