Therapeutic response to metformin in an underweight patient with polycystic ovarian syndrome

Objective: To report a case where insulin sensitization restored menses in an underweight woman with polycystic ovarian syndrome (PCOS). Design: Case report. Setting: Tertiary care center. Patient(s): A 19-year-old woman with a body mass index of 16.9 kg/m², severe hirsutism, and oligomenorrhea. Intervention(s): Insulin sensitization with metformin. Main Outcome Measure(s): Impact of metformin therapy on menstrual cycle and serum T and fasting insulin levels. Result(s): Metformin, without weight loss or increased physical activity, resulted in restoration of menstrual cycle, reduction in serum T, and improvement in insulin resistance (IR). Conclusion(s): This case highlights the contribution of PCOS-related IR, distinct from visceral adiposity, and demonstrates the effectiveness of pharmacological insulin-sensitization independent of weight loss or lifestyle adjustments.