The effectiveness of metformin, oral contraceptives, and lifestyle modification in improving the metabolism of overweight women with polycystic ovary syndrome: a network meta-analysis

Wang, Anran; Mo, Tingting; Li, Qiao; Shen, Chuangpeng; Liu, Min

doi:10.1007/s12020-019-01860-w

Cited by 20 publications

(10 citation statements)

References 41 publications

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“…Finally, there is reliable evidence regarding the use of metformin for anthropometric (reduction of body weight and decrease of waist) outcomes and COCPs for hyperandrogenism in women with PCOS (132). In fact, in overweight women with PCOS, metformin plus lifestyle changes might be the best intervention to improve IR and total triglycerides, whereas COCPs plus lifestyle changes appear to be the best intervention for the reduction of total cholesterol and LDL cholesterol, therefore suggesting a combined treatment with metformin and COCPs in these patients (133).…”

Section: Resolution 5: Evidence Supports That Medical Therapy For Wommentioning

confidence: 99%

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

et al. 2020

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Polycystic ovary syndrome (PCOS) is a very common endocrine and metabolic disorder with the involvement of both genetic and environmental factors. Although much has been clarified on its pathogenesis, diagnosis, clinical manifestations, and therapy, there are still areas of uncertainty. To address fundamental concepts, novel aspects and hypotheses, and future perspectives, including the possible additional benefits of treatment with nutraceuticals, an expert consensus panel formed by endocrinologists and gynecologists was established. After an independent review of the literature, the panel convened electronically on February 3, 2020, and six resolutions were created, debated, and agreed upon discussion, and finally approved in their final form in a consensus livestream meeting held on April 15. The summary of the resolutions are: (1) PCOS is a well-established medical condition that negatively affects reproduction, general health, sexual health, and quality of life; (2) the symptoms and signs of PCOS appear early in life especially in female newborns from PCOS carriers; (3) women with PCOS have significantly increased risk of pregnancy-related complications including gestational diabetes mellitus; (4) a male PCOS equivalent exists, and it may impact on metabolic health and probably on reproduction; (5) the evidence supports that medical therapy for PCOS is effective, rational, and evidence-based; (6) the evidence supports a major research initiative to explore possible benefits of nutraceutical therapy for PCOS. The proposed resolutions may be regarded as points of agreement based on the current scientific evidence available.

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Section: Resolution 5: Evidence Supports That Medical Therapy For Wommentioning

confidence: 99%

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

et al. 2020

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“…Effective, evidence-based dietary strategies for optimizing fertility in women with PCOS are essential. Previous meta-analyses mainly focus on the impact of pharmacological treatment or changes of lifestyle, exercise or single nutrient, and most of them pay attention to the endocrine and metabolism outcomes with few lectures evaluating the effects of diet on fertility in PCOS (22)(23)(24). Hence, it is warranted to define the effectiveness of diet in promoting reproductive health among women with PCOS, in order to provide appropriate dietary advice for clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Dietary Modification for Reproductive Health in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Shang

Zhou

et al. 2021

Front. Endocrinol.

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ObjectiveDiet has been reported as the first-line management of polycystic ovary syndrome (PCOS). However, the relationship between diet and fertility in PCOS is still controversial. This meta-analysis aimed to evaluate whether diet could promote reproductive health in women with PCOS while providing evidence-based nutrition advice for clinical practice.MethodsSeven databases, including Cochrane Central Register of Controlled Trials, PubMed, Embase, Web of Science, and some Chinese database, were searched up to January 31, 2021. Randomized controlled trials evaluating the effects of diet in women with PCOS were included. Based on a preregistered protocol (PROSPERO CRD42019140454), the systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two reviewers made study selection, data extraction and bias assessment independently. Risk ratios and mean difference with 95% confidence intervals were assessed by a random-effects model. Statistical heterogeneity within comparisons was evaluated by Cochran’s Q test and quantified by the I-squared (I2) statistic.ResultsTwenty RCTs with 1113 participants were included. Results showed diet significantly related to improved fertility outcomes (increasing clinical pregnancy, ovulation and menstrual regularity rate; reducing miscarriage rate), reproductive endocrine [increasing sex hormone-binding globulin (SHBG); decreasing Anti-Müllerian Hormone (AMH), free androgen index (FAI), total testosterone (T)] and clinical hyperandrogenism (hirsutism assessed by Ferriman-Gallwey score) in PCOS. Specifically, subgroup analyses indicated low-carbohydrate diets were superior in optimizing reproductive outcomes and calorie restriction was critical in ameliorating hyperandrogenism. Additionally, the positive effects were associated with the treatment duration. The longer the duration, the greater the improvement was.ConclusionOverall, diet is an effective intervention for improving fertility health, thus professional and dynamic dietary advice should be offered to all PCOS patients, based on the changeable circumstances, personal needs and expectations of the individuals.

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“…In a randomized placebocontrolled trial, atorvastatin significantly reduced insulin resistance, inflammatory markers, and hyperandrogenaemia in PCOS women compared to placebo (A. Wang et al, 2019). In a further 12 weeks, metformin followup both atorvastatin and placebo demonstrated significant improvements in HOMA-IR, the free androgen index (FAI), total testosterone and sex hormone-binding globuline (SEHBG), in atorvastatin pre-treated group compared to a placebo group when atorvastatin and placebo were followed up for a further 12 weeks (Moran et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Endocrine Therapy for Improved Reproductive and Metabolic Outcomes in PCOS Women

Rahmawati

Yunitasari

Armini

et al. 2021

Pediomaternal Nurs. J.

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Introduction: Polycystic ovarian syndrome (PCOS) is characterized by infrequent or absent ovulation as well as elevated levels of androgens and insulin (hyperinsulinaemia). The purpose of this study was to determine the efficacy of endocrine treatment in improving reproductive and metabolic outcomes in women with PCOS.Methods: We searched the following databases from inception to Maret 2020: PubMed, Proquest, ScienceDirect, Scopus and CINAHL. We investigated at metformin, clomiphene citrate, metformin plus clomiphene citrate, D-chiro-inositol, statins, and resveratrol as treatments. We compared them to each other, as well as to a placebo or no therapy. The quality of the evidence ranged from extremely low to moderate. The risks of bias (poor reporting of technique and inadequate outcome data), imprecision, and inconsistency were the limitations.Results: Although the evidence quality was low, our latest evaluation indicated that metformin alone may be superior to placebo for live birth. Data for live birth were equivocal when metformin was compared to clomiphene citrate, and our conclusions were hampered by a paucity of evidence. Body mass index (BMI) varies in the results, emphasizing the need of stratifying data by BMI.Conclusion: Clinical pregnancy and ovulation improvements demonstrate that clomiphene citrate is still preferred to metformin for ovulation induction in obese women with PCOS.

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The effectiveness of metformin, oral contraceptives, and lifestyle modification in improving the metabolism of overweight women with polycystic ovary syndrome: a network meta-analysis

Cited by 20 publications

References 41 publications

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

Dietary Modification for Reproductive Health in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

A Systematic Review of Endocrine Therapy for Improved Reproductive and Metabolic Outcomes in PCOS Women

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