American Board of Family Medicine (ABFM) Practice Exam

What medication can be added to the management of a patient with PCOS who presents with amenorrhea, obesity, and high testosterone levels?

1. Insulin

2. Metformin

3. Clomiphene

4. Spironolactone

The correct answer is: Metformin

The recommended medication to add for the management of a patient with polycystic ovary syndrome (PCOS) presenting with amenorrhea, obesity, and high testosterone levels is metformin. Metformin is primarily known for its role in managing insulin resistance, which is commonly seen in patients with PCOS. By improving insulin sensitivity, metformin can help lower circulating insulin levels, which may subsequently reduce ovarian androgen production, leading to decreased testosterone levels and potentially improving menstrual regularity. In addition to its effects on insulin resistance, metformin also has beneficial impacts on weight management, as it can promote modest weight loss in overweight individuals. This is significant in managing PCOS, as obesity can exacerbate symptoms and create a cyclical pattern of metabolic dysfunction. Furthermore, metformin may contribute to improved ovarian function and regular menstrual cycles, making it a useful first-line therapy in women with PCOS who are not attempting to conceive. Overall, its multifaceted approach targeting both metabolic and endocrine aspects makes metformin an appropriate choice for managing this condition. Other options, while relevant in different contexts, do not address the core issues associated with PCOS in this scenario as effectively as metformin does.