The Combined Effect of N-Acetyl Cysteine and Metformin in Polycystic Ovary Syndrome Patients

The study aims to evaluate the effects of combination of metformin with NAC in PCOS on biochemical and hormonal parameters.

Sex

Female

Minimum age

20 Years

Maximum age

45 Years

Inclusion Criteria:

1. Female aged 20 to 45 years old.
2. Confirmed diagnosis with PCOS according to the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS.
3. Ability to give informed consent.

Exclusion Criteria:

1. Hypersensitivity to either metformin or NAC.
2. Consumption of medications affecting carbohydrate metabolism, such as insulin, sulfonylureas, and taking hormonal analogues two months prior to enrollment.
3. Hyperprolactinemia, defined as a prolactin level above laboratory reference range.
4. Diabetes mellitus.
5. Thyroid dysfunction, subjects with elevated or low TSH level.
6. Renal impairment where creatinine clearance (CrCl) less than 30 ml/min.
7. Severe hepatic impairment, defined as significant biochemical abnormalities, including hypoalbuminemia and abnormal serum concentration (2-3 times the upper limit of normal), of at least two of the following liver function markers: total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), or gamma-glutamyl transferase (GGT).
8. Active alcohol abuse.
9. History of lactic acidosis during metformin therapy.
10. Active peptic ulcer.
11. Congenital adrenal hyperplasia.
12. Cushing's syndrome.
13. Androgen secreting neoplasia.
14. Patients who were using spironolactone, other anti-androgens, or any form of hormone therapy for the treatment of hirsutism at least 3 months before enrollment in the study.
15. Decompensated heart failure.

• BACKGROUNDTiganis T. Reactive oxygen species and insulin resistance: the good, the bad and the ugly. Trends Pharmacol Sci. 2011 Feb;32(2):82-9. doi: 10.1016/j.tips.2010.11.006. Epub 2010 Dec 14. PMID 21159388
• BACKGROUNDPei Y, Liu H, Yang Y, Yang Y, Jiao Y, Tay FR, Chen J. Biological Activities and Potential Oral Applications of N-Acetylcysteine: Progress and Prospects. Oxid Med Cell Longev. 2018 Apr 22;2018:2835787. doi: 10.1155/2018/2835787. eCollection 2018. PMID 29849877
• BACKGROUNDYifu P. A review of antioxidant N-acetylcysteine in addressing polycystic ovary syndrome. Gynecol Endocrinol. 2024 Dec;40(1):2381498. doi: 10.1080/09513590.2024.2381498. Epub 2024 Jul 22. PMID 39039898
• BACKGROUNDChrist JP, Cedars MI. Current Guidelines for Diagnosing PCOS. Diagnostics (Basel). 2023 Mar 15;13(6):1113. doi: 10.3390/diagnostics13061113. PMID 36980421
• BACKGROUNDGayatri K, Kumar JS, and Kumar BB. Metformin and N-acetyl cysteine in polycystic ovarian syndrome--a comparative study. Indian Journal of Clinical Medicine. 2023;15;24(18):14126. doi.org/10.1177/117739361000100002
• BACKGROUNDScholze A, Rinder C, Beige J, Riezler R, Zidek W, Tepel M. Acetylcysteine reduces plasma homocysteine concentration and improves pulse pressure and endothelial function in patients with end-stage renal failure. Circulation. 2004 Jan 27;109(3):369-74. doi: 10.1161/01.CIR.0000109492.65802.AD. Epub 2004 Jan 19. PMID 14732754
• BACKGROUNDFulghesu AM, Ciampelli M, Muzj G, Belosi C, Selvaggi L, Ayala GF, Lanzone A. N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome. Fertil Steril. 2002 Jun;77(6):1128-35. doi: 10.1016/s0015-0282(02)03133-3. PMID 12057717
• BACKGROUNDDe Mattia G, Bravi MC, Laurenti O, Cassone-Faldetta M, Proietti A, De Luca O, Armiento A, Ferri C. Reduction of oxidative stress by oral N-acetyl-L-cysteine treatment decreases plasma soluble vascular cell adhesion molecule-1 concentrations in non-obese, non-dyslipidaemic, normotensive, patients with non-insulin-dependent diabetes. Diabetologia. 1998 Nov;41(11):1392-6. doi: 10.1007/s001250051082.