Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/141458
Citations | ||
Scopus | Web of Science® | Altmetric |
---|---|---|
?
|
?
|
Type: | Journal article |
Title: | Metformin and combined oral contraceptive pills in the management of polycystic ovary syndrome: a systematic review and meta-analysis |
Author: | Melin, J. Forslund, M. Alesi, S. Piltonen, T. Romualdi, D. Spritzer, P.M. Tay, C.T. Pena, A. Witchel, S.F. Mousa, A. Teede, H. |
Citation: | Journal of Clinical Endocrinology and Metabolism, 2024; 109(2):e817-e836 |
Publisher: | Oxford University Press |
Issue Date: | 2024 |
ISSN: | 0021-972X 1945-7197 |
Statement of Responsibility: | Johanna Melin, Maria Forslund, Simon Alesi, Terhi Piltonen, Daniela Romualdi, Poli Mara Spritzer, Chau Thien Tay, Alexia Pena, Selma Feldman Witchel, Aya Mousa, and Helena Teede |
Abstract: | Context: Polycystic ovary syndrome (PCOS) affects more than 1 in 10 women. Objective: As part of the 2023 International PCOS Guidelines update, comparisons between combined oral contraceptive pills (COCP), metformin, and combination treatment were evaluated. Data Sources: Ovid Medline, Embase, PsycINFO, All EBM, and CINAHL were searched. Study Selection: Women with PCOS included in randomized controlled trials (RCTs). Data Extraction: We calculated mean differences and 95% CIs regarding anthropometrics, metabolic, and hyperandrogenic outcomes. Metaanalyses and quality assessment using GRADE were performed. Data Synthesis: The search identified 1660 publications; 36 RCTs were included. For hirsutism, no differences were seen when comparing metformin vs COCP, nor when comparing COCP vs combination treatment with metformin and COCP. Metformin was inferior on free androgen index (FAI) (7.08; 95% CI 4.81, 9.36), sex hormone binding globulin (SHBG) (−118.61 nmol/L; 95% CI −174.46, −62.75) and testosterone (0.48 nmol/L; 95% CI 0.32, 0.64) compared with COCP. COCP was inferior for FAI (0.58; 95% CI 0.36, 0.80) and SHBG (−16.61 nmol/L; 95% CI −28.51, −4.71) compared with combination treatment, whereas testosterone did not differ. Metformin lowered insulin (−27.12 pmol/L; 95% CI −40.65, −13.59) and triglycerides (−0.15 mmol/L; 95% CI −0.29, −0.01) compared with COCP. COCP was inferior for insulin (17.03 pmol/L; 95% CI 7.79, 26.26) and insulin resistance (0.44; 95% CI 0.17, 0.70) compared with combination treatment. Conclusions: 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). |
Keywords: | combined oral contraceptive pill hirsutism meta-analysis metformin polycystic ovary syndrome weight |
Description: | Advance access publication 9 August 2023 |
Rights: | © The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons. org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
DOI: | 10.1210/clinem/dgad465 |
Grant ID: | NHMRC |
Published version: | http://dx.doi.org/10.1210/clinem/dgad465 |
Appears in Collections: | Research Outputs |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
hdl_141458.pdf | Published version | 674.38 kB | Adobe PDF | View/Open |
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.