Oral contraceptives (OCs) in combination with metformin versus OCs alone on metabolism in nonobese polycystic ovary syndrome: a meta-analysis and systematic review of randomized controlled trials
Open accessAbstract
BACKGROUND: To compare OCs(oral contraceptives) + metformin and OCs alone for metabolic effects in nonobese polycystic ovary syndrome (PCOS) patients. METHODS: The search was performed in PubMed, EMBASE, the Cochrane Library and clinicaltrials.gov for all published studies up to 30 April 2022 and was limited to English-language articles. All randomized controlled trials (RCTs) comparing OCs + metformin and OCs alone for reproductive-age women with PCOS were included. Data were processed using Revman 5.3 software. RESULTS: Of 396 studies identified, 14 RCTs were included for analysis comprising 707 women. OCs+metformin significantly modified fasting glucose (MD = -0.21 [95% confidence interval (CI) = -0.31, -0.12], p < .00001) and fasting insulin (MD = -2.54 [95%CI = -4.04, -1.04], p = .0009) at study completion compared with OCs alone in nonobese PCOS subjects. There was no statistic difference in the homoeostasis model assessment of insulin resistance (HOMA-IR), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol or triglycerides at study end between the two groups. CONCLUSIONS: Metformin, via its positive effects on insulin clearance, in combination with OCs, improved glucose metabolism and offered a good treatment alternative in nonobese women with PCOS.
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Two systematic reviews found that adding metformin to COCP and anti-androgens improved BMI.
“Two systematic reviews found that adding metformin to COCP and anti-androgens improved BMI and glucose tolerance (11, 88).”
From Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis (2024) · cites this paper as [88]
The Abstract describes a systematic review comparing oral contraceptives plus metformin with oral contraceptives alone in nonobese women with PCOS. The outcomes listed in the Conclusion are glucose and lipid measures, not BMI; the review also does not assess adding metformin to an anti-androgen regimen. It therefore does not support the attributed BMI improvement. (LLM, conf=0.85)
Experimental — accuracy not yet measuredTwo systematic reviews found that adding metformin to COCP and anti-androgens improved glucose tolerance.
“Two systematic reviews found that adding metformin to COCP and anti-androgens improved BMI and glucose tolerance (11, 88).”
From Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis (2024) · cites this paper as [88]
The Overall results (§3.5.1) report lower fasting glucose with metformin plus oral contraceptives than with oral contraceptives alone in nonobese women with PCOS. The review does not report a glucose-tolerance outcome or evaluate adding metformin to a separate anti-androgen treatment, so those parts of the attributed claim are not established. (LLM, conf=0.86)
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“compared the metabolic effect of oral contraceptives and combination of oral contraceptives plus metformin in non-obese adult PCOS patients, and concluded that the combination of the two drugs achieved significant reduction of hyperinsulinemia, although the effect was mostly due to hepatic insulin clearance and not to…”
Background
- Authors
- Wu, L., Liu, Y., Huang, X., Lin, K., Liu, Y., Li, Z., Wei, T., Song, L., Hua, Y., & Wang, X.
- Affiliations
- Chengdu Second People's Hospital (CN)
- People's Hospital of Kaizhou District (CN)
- Department of Obstetrics and Gynecology Jianyang Maternal and Child Health Hospital Jianyang Sichuan People's Republic of China
- Dazhou Central Hospital (CN)
- Department of Obstetrics and Gynecology Bishan Hospital Chongqing People's Republic of China
- Second Affiliated Hospital of Chongqing Medical University (CN)
- Corresponding author
- Hua, Yuanyuan
- Wang, Xiaoli
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2023-04-07
- Volume
- 99
- Issue
- 1
- Pages
- 3-16
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W4321164479
- Cited by
- 17
- References
- 55
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 4
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Endocrinology (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
- oral contraceptives, metformin, polycystic ovary syndrome, non-obese women, glucose metabolism, fasting insulin, insulin resistance, HOMA-IR, dyslipidemia, insulin clearance
- MeSH terms
- Contraceptives, Oral, Female, Humans, Hypoglycemic Agents, Insulin, Metformin, Polycystic Ovary Syndrome, Randomized Controlled Trials as Topic
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