Gynaecological endocrinology: metformin in PCOS: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Gynaecological endocrinology: metformin in PCOS

Sample item

How does metformin help restore ovulation in an obese woman with PCOS?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. It lowers insulin resistance and hyperinsulinaemia, reducing ovarian androgen output

Hyperinsulinaemia acts with LH on theca cells to raise androgen production and suppresses hepatic SHBG. Metformin improves insulin sensitivity, so androgens fall and ovulation may resume.

Option by option

  • A. It inhibits aromatase in granulosa cells

    Aromatase inhibition is the mechanism of letrozole and not of metformin.

  • B. It lowers insulin resistance and hyperinsulinaemia, reducing ovarian androgen output (correct)

    Correct. Lower insulin reduces theca androgen production and may restore ovulation.

  • C. It directly stimulates FSH release

    Metformin has no direct pituitary stimulating action.

  • D. It blocks androgen receptors in the hair follicle

    Androgen receptor blockade is the action of spironolactone and cyproterone.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, It lowers insulin resistance and hyperinsulinaemia, reducing ovarian androgen output. Hyperinsulinaemia acts with LH on theca cells to raise androgen production and suppresses hepatic SHBG.

Why is "It inhibits aromatase in granulosa cells" not the answer?

Aromatase inhibition is the mechanism of letrozole and not of metformin.

Why is "It directly stimulates FSH release" not the answer?

Metformin has no direct pituitary stimulating action.

Why is "It blocks androgen receptors in the hair follicle" not the answer?

Androgen receptor blockade is the action of spironolactone and cyproterone.

What concept does this question test?

It tests Gynaecological endocrinology: metformin in PCOS in OBG. Metformin improves insulin sensitivity, so androgens fall and ovulation may resume.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological endocrinology: metformin in PCOS?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.