Meta-analysis evaluates combination contraceptives, metformin in PCOS

  • Teede H & al.
  • Clin Endocrinol (Oxf)
  • 14 May 2019

  • International Clinical Digest
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Takeaway

  • Combined oral contraceptive pills (COCP) and metformin have differential effects on menstrual regulation, fasting insulin, and BMI in adolescents and adults with PCOS, according to a systematic review and meta-analysis.

Why this matters

  • This study informed recently developed evidence-based guidelines.

Key results

  • In adolescents, metformin was superior to COCP for BMI (mean difference [MD], −4.02; P<.001 dysglycemia by oral glucose tolerance test and low-density lipoprotein cholesterol while cocp was superior to metformin for menstrual regulation>
  • In adults, metformin was superior to COCP for fasting insulin (MD, 4.00; P=.00001), while COCP was superior to metformin for sex hormone-binding globulin (MD, 118.25; P=.00001), free androgen index (MD, −6.61; P=.0001), total testosterone (MD, −0.38; P=.004), and irregular cycles (MD, 12.49; P=.03).

Study design

  • 56 studies were included in qualitative synthesis, while 46 studies were included in quantitative synthesis (meta-analysis).
  • Funding: National Health and Medical Research Council of Australia, European Society of Human Reproduction and Embryology, American Society for Reproductive Medicine.

Limitations

  • Low-quality evidence for most outcomes.