Effect of the combined oral contraceptive pill and/or metformin in the management of polycystic ovary syndrome: A systematic review with meta-analyses

摘要: BACKGROUND Polycystic ovary syndrome (PCOS) has a prevalence of 8%-13%. Given the prevalence, diverse health impacts and variation in care, rigorous evidence-based guidelines are needed PCOS management. This systematic review with meta-analyses aimed to investigate effect combined oral contraceptive pill (COCP) and/or metformin management hormonal clinical features PCOS, inform international guidelines. METHODS Electronic databases were searched systematically from inception until 11 January 2017 guideline process. Eligible studies randomized controlled trials which investigated COCPs alone or on women PCOS. Outcomes prioritized as critical for informing decision about an intervention important not important, according GRADE. Articles assessed by one author against selection criteria, consultation second author. Data double extracted independently four authors, data quality appraisal was completed. Meta-analyses conducted, where appropriate. RESULTS Fifty-six eligible inclusion. professionals included following: irregular cycles, insulin resistance, weight, BMI, thromboembolic events gastrointestinal effects. In low-quality evidence adolescents, demonstrated that better than COCP BMI (mean difference [MD] -4.02 [-5.23, -2.81], P < 0.001); menstrual regulation (MD -0.19 [-0.25, -0.13], P < 0.00001). adults, placebo -0.48 [-0.94, -0.02], P = 0.04); fasting 4.00 [2.59, 5.41], P = 0.00001), whereas cycles 12.49 [1.34, 116.62], P = 0.03). Combined combination anti-androgen -3.04 [-5.45, -0.64], P = 0.01). Metformin associated generally mild adverse events. Differences statistical significance observed when outcomes subgrouped BMI. CONCLUSIONS identified therapy benefits hyperandrogenism regulation. may be useful metabolic features. There is minimal adding therapy. adult outcomes, especially BMI ≥ 25 kg/m2 . inadequate suggest optimal formulation, dosing regimen formulation metformin.