American Board of Internal Medicine (ABIM) Certification Practice Exam

For patients with PCOS who cannot tolerate oral contraceptive pills, what is considered the second-line therapy?

1. Insulin therapy

2. Metformin

3. Estrogen patches

4. Clomiphene citrate

The correct answer is: Metformin

In the management of polycystic ovary syndrome (PCOS), particularly for patients who are unable to tolerate oral contraceptive pills, metformin is often regarded as the second-line therapy. Metformin is primarily used for its role in improving insulin sensitivity, which is a common issue in PCOS patients who frequently exhibit insulin resistance. By enhancing the body’s response to insulin, metformin can help regulate menstrual cycles, promote ovulation, and improve metabolic parameters such as glucose levels and body weight in those with PCOS. This makes it particularly beneficial for individuals looking to manage symptoms associated with the condition. Other potential treatments, like insulin therapy, may be appropriate in specific cases but are not primarily considered as a first or second-line option; they generally come into play when managing more severe insulin resistance or diabetes that may also present in PCOS. Estrogen patches and clomiphene citrate are used in different contexts; estrogen patches are typically not indicated for managing PCOS symptoms directly, and clomiphene citrate is more commonly used as a first-line therapy for inducing ovulation, particularly in women desiring fertility. However, for those who cannot tolerate oral contraceptive pills, metformin serves as a more appropriate and effective choice for addressing the