Comparative Efficacy of Metformin and Combined Oral Contraceptives in the Management of Adolescent Polycystic Ovary Syndrome: A Systematic Review of Randomized Controlled Trials

TL;DR

This study compares metformin and birth control pills for treating PCOS in teens, finding that metformin-based treatments improve both reproductive and metabolic health better than birth control alone.

Contribution

The study provides a systematic review comparing metformin, COCs, and their combination in adolescent PCOS management, highlighting insulin-sensitizing therapies as more effective.

Findings

COCs reduce hyperandrogenic symptoms but increase metabolic risks like insulin resistance.

Combination therapies like SPIOMET improve ovulation rates and insulin sensitivity with fewer side effects.

Metformin combined with COCs offers balanced improvements in both reproductive and metabolic outcomes.

Abstract

This systematic review explores the comparative efficacy of metformin, combined oral contraceptives (COCs), and their combination in the management of polycystic ovary syndrome (PCOS) among adolescent females. A comprehensive literature search was conducted across PubMed, Scopus, and Cochrane CENTRAL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, yielding 645 records, of which seven randomized controlled trials (RCTs) met the inclusion criteria. The included studies varied in design, population size, and outcome focus but consistently evaluated metabolic, hormonal, and reproductive endpoints. Results indicated that, while COCs were effective in reducing hyperandrogenic symptoms and regulating menstrual cycles, they were often associated with adverse metabolic effects, such as increased hepatic enzymes and insulin resistance. In contrast, insulin-sensitizing agents, particularly in combination regimens such as SPIOMET (spironolactone, pioglitazone, and metformin combination), showed superior outcomes in improving ovulation rates, insulin sensitivity, and body composition, with fewer metabolic side effects. Combination therapy with metformin and COCs also demonstrated a balanced improvement in both reproductive and metabolic profiles. The overall quality of included studies was rated as having some concerns due to variability in study design and reporting. Despite these limitations, the evidence supports a more individualized and metabolically focused approach to managing adolescent PCOS, emphasizing the benefits of early intervention with insulin-sensitizing therapies.

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