Effect of metformin on clinical, metabolic and endocrine outcomes in women with polycystic ovary syndrome: a meta-analysis of randomized controlled trials
Abstract
OBJECTIVE: Metformin has been used as a treatment option for polycystic ovary syndrome (PCOS) since 1994; however, more than a hundred randomized clinical trials have reported controversial results regarding the efficacy of metformin in PCOS. This could be due to the small sample size and high variability in methodology between studies. The objective of the present meta-analysis was to determine the effect of metformin on clinical, metabolic, and endocrine outcomes compared to placebo in PCOS women. METHODS: Randomized controlled trials evaluating the efficacy of metformin were identified using a literature search in PubMed. Bibliographies of relevant studies were also screened to identify additional studies. Data was extracted from included studies and analyzed using RevMan software 5.3 from the Cochrane Collaboration. MAIN OUTCOME MEASURES: Clinical outcomes included body mass index, waist to hip ratio, systolic and diastolic blood pressure and Ferriman-Gallway score. Metabolic outcomes included total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, very low-density lipoprotein, fasting blood glucose, fasting insulin levels, glucose insulin ratio, HOMA-IR and QUICKI. Endocrine outcomes such as serum testosterone, free testosterone, free androgen index, serum sex hormone binding globulin, dehydroepiandrosterone sulfate, luteinizing hormone, follicle stimulating hormone, LH/FSH ratio, estradiol, and progesterone levels. CONCLUSION: Metformin showed significant improvement in clinical outcomes but not in metabolic and endocrine outcomes in PCOS women; however, heterogeneity between studies was found to be moderate to high.
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A meta-analysis by Patel and Shah of 13 randomized controlled trials and 506 subjects reported no impact of metformin on fasting glucose levels, with mean difference −1.38 mmol/L (95% CI −3.71, 0.94).
“On the contrary, a second meta-analysis performed by Patel and Shah [48] centred on metabolic outcomes of treatment with metformin versus placebo, synthetizing data on fasting blood glucose (FBG) levels of 13 randomized controlled trials (RCTs) and 506 subjects, reported no impact of metformin on fasting glucose levels (MD −1.38 mmol/L; 95% CI −3.71, 0.94).”
From From Prediabetes to Type 2 Diabetes Mellitus in Women with Polycystic Ovary Syndrome: Lifestyle and Pharmacological Management (2020) · cites this paper as [48]
A meta-analysis showed metformin decreased BMI and waist-to-hip ratio in 11 and 7 RCTs of PCOS women, respectively, compared to placebo.
“However, a meta-analysis showed that metformin contributed to a decrease of body mass index (BMI) and waist to hip ratio (WHR) in 11 and 7 RCTs of PCOS women respectively, compared to placebo (75).”
From GDF-15 as a Weight Watcher for Diabetic and Non-Diabetic People Treated With Metformin (2020) · cites this paper as [75]
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Krysiak, R. G., Simental-Mendía, M. A., & Simental‐Mendía, L. E. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70719
- Authors
- Patel, R., & Shah, G.
- Affiliations
- Department of Pharmacology and Clinical Pharmacy, K.B. Institute of Pharmaceutical Education and Research, Gandhinagar, Gujarat, India;
- Department of Pharmacology, L.M. College of Pharmacy, Ahmedabad, Gujarat, India
- Corresponding author
- Patel, Roshni
- ORCID
- Shah, Gaurang
- Venue
- Current Medical Research and Opinion
- Publisher
- Informa UK Limited
- Published
- 2017-02-03
- Volume
- 33
- Issue
- 9
- Pages
- 1545-1557
- ISSN
- 0300-7995 (ISSN-L)
- 1473-4877
- OpenAlex
- W2571035512
- Cited by
- 47
- References
- 57
- Citations by year
- 2026: 1 · 2024: 4 · 2023: 4 · 2022: 7 · 2021: 10 · 2020: 3 · 2019: 5 · 2018: 9 · 2017: 4
- FWCI
- 0.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Medical Research and Opinion (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Keywords
- metformin, polycystic ovary syndrome, body mass index, waist-to-hip ratio, blood pressure, lipid profile, fasting insulin, insulin resistance, HOMA-IR, QUICKI, testosterone, free androgen index, sex hormone-binding globulin, luteinizing hormone, follicle-stimulating hormone, estradiol, progesterone, placebo comparison
- MeSH terms
- Female, Follicle Stimulating Hormone, Humans, Hypoglycemic Agents, Luteinizing Hormone, Lipoproteins, HDL, Lipoproteins, LDL, Metformin, Polycystic Ovary Syndrome, Sex Hormone-Binding Globulin, Testosterone, Randomized Controlled Trials as Topic
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