Impact of Pharmacological Interventions on Anthropometric Indices in Women With Polycystic Ovary Syndrome

A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Mohammed A. Abdalla; Najeeb Shah; Harshal Deshmukh; Amirhossein Sahebkar; Linda Östlundh; Rami H. Al-Rifai PhD; Stephen L. Atkin; Thozhukat Sathyapalan


Clin Endocrinol. 2022;96(6):758-780. 

In This Article

Abstract and Introduction


Context: Polycystic ovary syndrome (PCOS) is a heterogeneous condition affecting women of reproductive age and is associated with increased body weight.

Objective: To review the literature on the effect of different pharmacological interventions on the anthropometric indices in women with PCOS.

Data Sources: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane library, and the Web of Science in April 2020 with an update in PubMed in March 2021.

Study Selection: The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)2020.

Data Extraction: Reviewers extracted data and assessed the risk of bias using the Cochrane risk of bias tool.

Results: 80 RCTs were included in the meta-analysis. Metformin vs placebo showed significant reduction in the mean body weight (MD: −3.13 kg; 95% confidence interval [CI]: −5.33 to −0.93, I 2 = 5%) and the mean body mass index (BMI) (MD: −0.75 kg/m2; 95% CI: −1.15 to −0.36, I 2 = 0%). There was a significant reduction in the mean BMI with orlistat versus placebo (MD: −1.33 kg/m2; 95% CI: −2.16 to −0.66, I 2 = 0.0%), acarbose versus metformin (MD: −1.26 kg/m2; 95% CI: −2.13 to −0.38, I 2 = 0%), and metformin versus pioglitazone (MD: −0.91 kg/m2; 95% CI: −1.62 to −0.19, I 2 = 0%). A significant increase in the mean BMI was also observed in pioglitazone versus placebo (MD: + 2.59 kg/m2; 95% CI: 1.78–3.38, I 2 = 0%) and in rosiglitazone versus metformin (MD: + 0.80 kg/m2; 95% CI: 0.32–1.27, I 2 = 3%). There was a significant reduction in the mean waist circumference (WC) with metformin versus placebo (MD: −1.21 cm; 95% CI: −3.71 to 1.29, I 2 = 0%) while a significant increase in the mean WC with pioglitazone versus placebo (MD: + 5.45 cm; 95% CI: 2.18–8.71, I 2 = 0%).

Conclusion: Pharmacological interventions including metformin, sitagliptin, pioglitazone, rosiglitazone orlistat, and acarbose have significant effects on the anthropometric indices in women with PCOS.


Polycystic ovary syndrome (PCOS) is a heterogeneous and complex endocrine disorder affecting women of reproductive age, with a prevalence ranging from 8% to 13%.[1,2] PCOS is characterized by both clinical and biochemical evidence of excess androgen levels (manifested as acne and hirsutism), menstrual irregularities, and sonographic polycystic ovarian morphology.[3] Metabolic disorders such as insulin resistance (IR) and impaired glucose tolerance are common in women with PCOS, leading to an increased risk of type 2 diabetes mellitus (T2DM).[4] Moreover, PCOS predisposes to a range of other complications including infertility, increased body weight, increased risk of cardiovascular disease (CVD), and endometrial cancer.[5–7]

Increased body weight is a prominent feature of PCOS and around 50% of women with PCOS are either overweight or obese.[8] Obesity exacerbates PCOS features such as excessive hair growth, infertility, and pregnancy complications, aggravating IR, which culminates in an increased metabolic risk associated with PCOS.[9] Therapeutic approaches including lifestyle modifications through dietary interventions and physical activity are the cornerstone in the management of PCOS.[10] There are also differing pharmacotherapeutic interventions including insulin sensitizers (metformin and thiazolidinediones) that improve IR and peripheral glucose uptake.[11,12] However, these therapeutic options are primarily licensed to treat other conditions such as T2DM and their effectiveness in PCOS remains unclear in the literature. There are also significant gaps between the available evidence and the evidence-based treatment options.[3] This might often lead to the delay in offering satisfactory treatment options and the clinical inertia around treating PCOS.[3] Therefore, this systematic review and meta-analysis aimed to evaluate and analyze the available evidence on the effectiveness of different therapeutic options used to treat PCOS in improving anthropometric outcomes.