Supplementary Material. Metformin and combined oral contraceptive pills in the management of polycystic ovary syndrome: a systematic review and meta-analysis.
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Supplementary material including GRADE tables, forest plots and search strategy for meta-analysis of metformin and combined oral contraceptive pills in polycystic ovary syndrome (PCOS).
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In subgroup analyses according to BMI and adults/adolescents, no differences were seen on WHR.
“In subgroup analyses according to BMI and adults/adolescents no differences were seen on weight, BMI and WHR (Supplementary Table S1; Supplementary Figs. S2 and S3) (23).”
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 [23]
In subgroup analyses comparing metformin with COCP with and without CPA, there were no differences in weight.
“In subgroup analyses comparing metformin with COCP with and without CPA (Supplementary Table S2; Supplementary Fig. S4) (23) there were no differences in weight.”
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 [23]
In subgroup analyses according to BMI and adults/adolescents, no differences were seen on BMI.
“In subgroup analyses according to BMI and adults/adolescents no differences were seen on weight, BMI and WHR (Supplementary Table S1; Supplementary Figs. S2 and S3) (23).”
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 [23]
In subgroup analyses according to BMI and adults/adolescents, no differences were seen on weight.
“In subgroup analyses according to BMI and adults/adolescents no differences were seen on weight, BMI and WHR (Supplementary Table S1; Supplementary Figs. S2 and S3) (23).”
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 [23]
In women with PCOS and a BMI < 25 kg/m2, metformin was less effective than COCP in treating hirsutism (MD 1.73; 95% CI, 0.07 to 3.40).
“Subgroup analysis categorized by BMI (Supplementary Table S1; Supplementary Fig. S2) (23) showed that in women with PCOS and a BMI < 25 kg/m2, metformin was less effective than COCP in treating hirsutism (MD 1.73; 95% CI, 0.07 to 3.40) and improving FAI (MD 5.78; 95% CI, 2.82 to 8.73), total testosterone (MD 0.56 nmol/L; 95% CI, 0.29 to 0.83), and SHBG (MD −168 nmol/L; 95% CI, −211 to −124).”
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 [23]
None of the identified studies reported hirsutism as an outcome for the comparison of metformin with metformin + COCP.
“Metformin was inferior for DHEAS (MD 82.38 μmol/L; 95% CI, 15.43 to 149.36) and total testosterone (MD 0.64 nmol/L; 95% CI, 0.26 to 1.02). None of the identified studies reported hirsutism as an outcome for this comparison (Table 5; Supplementary Fig. S6 (23)).”
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 [23]
Metformin was inferior for DHEAS compared with metformin + COCP (MD 82.38 μmol/L; 95% CI, 15.43 to 149.36).
“Metformin was inferior for DHEAS (MD 82.38 μmol/L; 95% CI, 15.43 to 149.36) and total testosterone (MD 0.64 nmol/L; 95% CI, 0.26 to 1.02). None of the identified studies reported hirsutism as an outcome for this comparison (Table 5; Supplementary Fig. S6 (23)).”
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 [23]
Metformin was superior for total cholesterol in adults (MD −0.34 mmol/L; 95% CI, −0.60 to −0.08).
“Metformin was also superior for total cholesterol, both in adults (MD −0.34 mmol/L; 95% CI, −0.60 to −0.08) and for adolescents (MD −1.12 mmol/L; 95% CI, −1.74 to −0.50) (Supplementary Table S1) (23).”
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 [23]
The type of COCP did not influence the overall results regarding clinical and biochemical hyperandrogenism.
“The type of COCP did not influence the overall results regarding clinical and biochemical hyperandrogenism (Supplementary Table S2; Supplementary Fig. S4) (23).”
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 [23]
In subgroup analyses on women with a BMI ≥ 25 kg/m2, the metformin-treated group had lower CRP compared with COCP (MD −33.09 nmol/L; 95% CI, −47.33 to −18.84).
“In subgroup analyses on women with a BMI ≥ 25 kg/m2 (Supplementary Fig. S2; Supplementary Table S1) (23), the metformin-treated group had lower CRP (MD −33.09 nmol/L; 95% CI, −47.33 to −18.84) and HDL (MD −0.24 mmol/L; 95% CI, −0.38 to −0.09) compared with COCP.”
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 [23]
In women with PCOS and a BMI < 25 kg/m2, metformin was less effective than COCP in improving total testosterone (MD 0.56 nmol/L; 95% CI, 0.29 to 0.83).
“Subgroup analysis categorized by BMI (Supplementary Table S1; Supplementary Fig. S2) (23) showed that in women with PCOS and a BMI < 25 kg/m2, metformin was less effective than COCP in treating hirsutism (MD 1.73; 95% CI, 0.07 to 3.40) and improving FAI (MD 5.78; 95% CI, 2.82 to 8.73), total testosterone (MD 0.56 nmol/L; 95% CI, 0.29 to 0.83), and SHBG (MD −168 nmol/L; 95% CI, −211 to −124).”
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 [23]
In women with PCOS and a BMI < 25 kg/m2, metformin was less effective than COCP in improving SHBG (MD −168 nmol/L; 95% CI, −211 to −124).
“Subgroup analysis categorized by BMI (Supplementary Table S1; Supplementary Fig. S2) (23) showed that in women with PCOS and a BMI < 25 kg/m2, metformin was less effective than COCP in treating hirsutism (MD 1.73; 95% CI, 0.07 to 3.40) and improving FAI (MD 5.78; 95% CI, 2.82 to 8.73), total testosterone (MD 0.56 nmol/L; 95% CI, 0.29 to 0.83), and SHBG (MD −168 nmol/L; 95% CI, −211 to −124).”
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 [23]
In subgroup analyses on women with a BMI ≥ 25 kg/m2, the metformin-treated group had lower HDL compared with COCP (MD −0.24 mmol/L; 95% CI, −0.38 to −0.09).
“In subgroup analyses on women with a BMI ≥ 25 kg/m2 (Supplementary Fig. S2; Supplementary Table S1) (23), the metformin-treated group had lower CRP (MD −33.09 nmol/L; 95% CI, −47.33 to −18.84) and HDL (MD −0.24 mmol/L; 95% CI, −0.38 to −0.09) compared with COCP.”
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 [23]
In women with PCOS and a BMI < 25 kg/m2, metformin was less effective than COCP in improving FAI (MD 5.78; 95% CI, 2.82 to 8.73).
“Subgroup analysis categorized by BMI (Supplementary Table S1; Supplementary Fig. S2) (23) showed that in women with PCOS and a BMI < 25 kg/m2, metformin was less effective than COCP in treating hirsutism (MD 1.73; 95% CI, 0.07 to 3.40) and improving FAI (MD 5.78; 95% CI, 2.82 to 8.73), total testosterone (MD 0.56 nmol/L; 95% CI, 0.29 to 0.83), and SHBG (MD −168 nmol/L; 95% CI, −211 to −124).”
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 [23]
Fasting insulin was lower with metformin regardless of BMI.
“Fasting insulin was lower with metformin regardless of BMI (Supplementary Table S1; Supplementary Fig. S2) (23).”
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 [23]
Metformin was inferior for total testosterone compared with metformin + COCP (MD 0.64 nmol/L; 95% CI, 0.26 to 1.02).
“Metformin was inferior for DHEAS (MD 82.38 μmol/L; 95% CI, 15.43 to 149.36) and total testosterone (MD 0.64 nmol/L; 95% CI, 0.26 to 1.02). None of the identified studies reported hirsutism as an outcome for this comparison (Table 5; Supplementary Fig. S6 (23)).”
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 [23]
In women with PCOS, metformin alone showed marginally lower CRP compared with combination treatment.
“Metformin alone showed marginally lower fasting glucose (MD −0.33 mmol/L; 95% CI, −0.64 to −0.01) and CRP (MD −4.08 nmol/L; 95% CI, −6.01 to −2.16), compared with a combination treatment (Table 5; Supplementary Fig. S6 (23)).”
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 [23]
In women with PCOS, COCP alone increased fasting insulin compared with combination treatment.
“COCP alone increased fasting insulin (MD 17.03 pmol/L; 95% CI, 7.79 to 26.26), HOMA-IR (MD 0.44; 95% CI, 0.17 to 0.70), and CRP (MD 1.94 nmol/L; 95% CI, 0.05 to 3.84) compared with combination treatment (Table 4; Supplementary Fig. S5 (23)).”
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 [23]
In women with PCOS, COCP alone increased HOMA-IR compared with combination treatment.
“COCP alone increased fasting insulin (MD 17.03 pmol/L; 95% CI, 7.79 to 26.26), HOMA-IR (MD 0.44; 95% CI, 0.17 to 0.70), and CRP (MD 1.94 nmol/L; 95% CI, 0.05 to 3.84) compared with combination treatment (Table 4; Supplementary Fig. S5 (23)).”
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 [23]
Metformin was superior for total cholesterol in adolescents (MD −1.12 mmol/L; 95% CI, −1.74 to −0.50).
“Metformin was also superior for total cholesterol, both in adults (MD −0.34 mmol/L; 95% CI, −0.60 to −0.08) and for adolescents (MD −1.12 mmol/L; 95% CI, −1.74 to −0.50) (Supplementary Table S1) (23).”
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 [23]
The type of COCP showed no major differences compared with the overall result.
“The type of COCP showed no major differences compared with the overall result (Supplementary Table S2) (23).”
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 [23]
In women with PCOS, metformin alone showed marginally lower fasting glucose compared with combination treatment.
“Metformin alone showed marginally lower fasting glucose (MD −0.33 mmol/L; 95% CI, −0.64 to −0.01) and CRP (MD −4.08 nmol/L; 95% CI, −6.01 to −2.16), compared with a combination treatment (Table 5; Supplementary Fig. S6 (23)).”
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 [23]
In women with PCOS, COCP alone increased CRP compared with combination treatment.
“COCP alone increased fasting insulin (MD 17.03 pmol/L; 95% CI, 7.79 to 26.26), HOMA-IR (MD 0.44; 95% CI, 0.17 to 0.70), and CRP (MD 1.94 nmol/L; 95% CI, 0.05 to 3.84) compared with combination treatment (Table 4; Supplementary Fig. S5 (23)).”
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 [23]
Cited by
Sorted by citations
Melin, J., Forslund, M., Alesi, S., Piltonen, T., Romualdi, D., Spritzer, P. M., Tay, C. T., Pena, A., Witchel, S. F., Mousa, A., et al. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad465 · Cited by 78 · see citing works
Self-citation
- Authors
- Melin, J., Forslund, M., Alesi, S., Piltonen, T., Romualdi, D., Spritzer, P. M., Tay, C. T., Pena Vargas, A., Witchel, S. F., Mousa, A., & Teede, H.
- Affiliations
- Region Stockholm (SE)
- Universidade Federal do Rio Grande do Sul (BR)
- University of Adelaide
- Monash University (AU)
- ORCID
- Venue
- Monash University
- Publisher
- Monash University
- Published
- 2023
- OpenAlex
- W6927325761
- Cited by
- 0
- References
- 0
- Type
- supplementary materials
- Language
- en
- Open access
- green
- figshare.com
- Licence
- Locations
- Figshare (submittedVersion, cc-by)
- Monash University (cc-by)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- metformin, combined oral contraceptives, polycystic ovary syndrome, PCOS management, insulin sensitizers, hormonal contraception
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