Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis
Authors' conclusion
The choice of metformin or COCP treatment should be based on symptoms, noting some biochemical benefits from combination treatment targeting both major endocrine disturbances seen in PCOS (hyperinsulinemia and hyperandrogenism).
Study context
- Population
- Women with polycystic ovary syndrome (PCOS) in randomized controlled trials (RCTs)36 RCTs
- Comparison
- Metformin vs combined oral contraceptive pills (COCP) vs combination
- Outcome
- Anthropometric, metabolic and hyperandrogenic outcomes
Methodological detailsGRADE quality assessment, part of 2023 International PCOS Guidelines update
- GRADE quality assessment
- Part of 2023 International PCOS Guidelines update
Pooled result
As reported in the abstract
- Metformin vs COCP · metformin inferior
- MD, free androgen index (FAI) 7.08 (95% CI 4.81–9.36)
- Metformin vs COCP · metformin inferior
- MD, sex hormone binding globulin (SHBG) −118.61 nmol/L (95% CI −174.46 to −62.75)
- Metformin vs COCP · metformin inferior
- MD, testosterone 0.48 nmol/L (95% CI 0.32–0.64)
- COCP vs Combination · COCP inferior
- MD, FAI 0.58 (95% CI 0.36–0.80)
- COCP vs Combination · COCP inferior
- MD, SHBG −16.61 nmol/L (95% CI −28.51 to −4.71)
- Metformin vs COCP · lower with metformin
- MD, insulin −27.12 pmol/L (95% CI −40.65 to −13.59)
- Metformin vs COCP · lower with metformin
- MD, TG −0.15 mmol/L (95% CI −0.29 to −0.01)
- COCP vs Combination · COCP inferior
- MD, insulin 17.03 pmol/L (95% CI 7.79–26.26)
- COCP vs Combination · COCP inferior
- MD, insulin resistance 0.44 (95% CI 0.17–0.70)
Original publication
Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab. Published 9 August 2023. doi:10.
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