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Spironolactone + metformin is a combination therapy consisting of the antiandrogenic mineralocorticoid receptor antagonist spironolactone and the biguanide insulin sensitizer metformin. This combination is primarily investigated and used off-label for the management of polycystic ovary syndrome (PCOS), particularly in adolescent and young women. Spironolactone addresses hyperandrogenism-related symptoms such as hirsutism and acne by blocking androgen receptors and inhibiting androgen synthesis. Metformin improves insulin sensitivity and reduces hepatic glucose production by activating AMP-activated protein kinase (AMPK), which helps address the metabolic dysfunction and menstrual irregularity associated with PCOS. Clinical research indicates that the combination provides complementary effects, often showing superior efficacy in reducing body mass index (BMI), serum testosterone levels, and insulin resistance compared to monotherapy with either agent.
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