Effect of metformin plus statin combination therapy compared to metformin alone in infertile woman with symptomatic endometrioma

Hritu Shah; Fawzia Hossain; M. Ariful Islam; Rebeka Sultana; Mostafa M. Al Tarique; Chowdhury Faisal Alamgir; Maliha Darmini; Nur-Wa-Bushra Jahan; Jesmine Banu

doi:10.18203/2320-1770.ijrcog20251982

Authors

Hritu Shah Department of Reproductive Endocrinology and Infertility, Bangladesh Medical University, Dhaka, Bangladesh
Fawzia Hossain Department of Gynaecological Oncology, Bangladesh Medical University, Dhaka, Bangladesh
M. Ariful Islam Department of Reproductive Endocrinology and Infertility, Bangladesh Medical University, Dhaka, Bangladesh
Rebeka Sultana Department of Reproductive Endocrinology and Infertility (OSD), Directorate General of Health Services (DGHS), Dhaka, Bangladesh
Mostafa M. Al Tarique Department of Reproductive Endocrinology and Infertility, Bangladesh Medical University, Dhaka, Bangladesh
Chowdhury Faisal Alamgir Department of Urology, New Cross Hospital, The Royal Wolverhampton NHS Trust, United Kingdom
Maliha Darmini Department of Gynecology, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh
Nur-Wa-Bushra Jahan Department of Obstetrics and Gynaecology (OSD), Directorate General of Health Services (DGHS), Dhaka, Bangladesh
Jesmine Banu Department of Reproductive Endocrinology and Infertility, Bangladesh Medical University, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20251982

Keywords:

Endometrioma, Statin, Metformin, Complement

Abstract

Background: Endometriosis is an estrogen-dependent inflammatory condition characterized by endometrial tissue growth outside the uterus. Metformin suppresses estrogen production and has anti-inflammatory, anti-proliferative, and anti-angiogenic effects. Statins inhibit cholesterol synthesis and offer anti-inflammatory actions, reducing angiogenesis, invasion, adhesion, and lowering MCP-1 and MMP-3 levels. This study compares metformin plus statin versus metformin alone in infertile women with symptomatic endometrioma.

Methods: A randomized controlled trial was conducted in the department of reproductive endocrinology and infertility, BSMMU. Forty women with symptomatic endometrioma diagnosed via transvaginal ultrasound (TVS) were randomized into two groups. The experimental group received metformin 500 mg thrice daily plus atorvastatin 40 mg once daily; the control group received only metformin. Treatment lasted 3 months. Outcomes-endometrioma size (TVS), pain [visual analog scale (VAS)], and complement C3 level (Nephelometry)-were measured pre-and post-treatment. Data were analyzed using SPSS v.26.

Results: After treatment, the experimental group showed significant reductions in endometrioma size (3.50±0.82 vs 2.41±0.52 cm) and pain score (6.80±1.67 vs 3.13±2.32) from baseline (p<0.05). The control group showed significant reductions in endometrioma size (3.40±0.96 vs 2.92±0.80 cm) and pain score (6.65±2.10 vs 3.47±2.09) from baseline (p<0.05). Serum complements levels increased in both groups insignificantly. Endometrioma size reduction was significantly higher in the experimental group (1.06±0.53 vs 0.45±0.44 cm), but pain score and complement level reductions showed no significant difference between groups.

Conclusions: Metformin plus statin shows significantly better reduction in endometrioma size compared to Metformin alone in treating symptomatic endometrioma in infertile women.

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