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Abstract：
BACKGROUND: Polycystic ovary syndrome (PCOS) affects more than 1 in 10 women.
OBJECTIVE: As part of the 2023 International PCOS Guidelines update, comparisons between combined oral contraceptive pills (COCP), metformin, and combination treatment were evaluated.
METHODS: Ovid Medline, Embase, PsycINFO, All EBM, and CINAHL were searched.
METHODS: Women with PCOS included in randomized controlled trials (RCTs).
METHODS: We calculated mean differences and 95% CIs regarding anthropometrics, metabolic, and hyperandrogenic outcomes. Meta-analyses and quality assessment using GRADE were performed.
RESULTS: The search identified 1660 publications; 36 RCTs were included. For hirsutism, no differences were seen when comparing metformin vs COCP, nor when comparing COCP vs combination treatment with metformin and COCP. Metformin was inferior on free androgen index (FAI) (7.08; 95% CI 4.81, 9.36), sex hormone binding globulin (SHBG) (-118.61 nmol/L; 95% CI -174.46, -62.75) and testosterone (0.48 nmol/L; 95% CI 0.32, 0.64) compared with COCP. COCP was inferior for FAI (0.58; 95% CI 0.36, 0.80) and SHBG (-16.61 nmol/L; 95% CI -28.51, -4.71) compared with combination treatment, whereas testosterone did not differ. Metformin lowered insulin (-27.12 pmol/L; 95% CI -40.65, -13.59) and triglycerides (-0.15 mmol/L; 95% CI -0.29, -0.01) compared with COCP. COCP was inferior for insulin (17.03 pmol/L; 95% CI 7.79, 26.26) and insulin resistance (0.44; 95% CI 0.17, 0.70) compared with combination treatment.
CONCLUSIONS: The choice of metformin or COCP treatment should be based on symptoms, noting some biochemical benefits from combination treatment targeting both major endocrine disturbances seen in PCOS (hyperinsulinemia and hyperandrogenism).
OBJECTIVE: As part of the 2023 International PCOS Guidelines update, comparisons between combined oral contraceptive pills (COCP), metformin, and combination treatment were evaluated.
METHODS: Ovid Medline, Embase, PsycINFO, All EBM, and CINAHL were searched.
METHODS: Women with PCOS included in randomized controlled trials (RCTs).
METHODS: We calculated mean differences and 95% CIs regarding anthropometrics, metabolic, and hyperandrogenic outcomes. Meta-analyses and quality assessment using GRADE were performed.
RESULTS: The search identified 1660 publications; 36 RCTs were included. For hirsutism, no differences were seen when comparing metformin vs COCP, nor when comparing COCP vs combination treatment with metformin and COCP. Metformin was inferior on free androgen index (FAI) (7.08; 95% CI 4.81, 9.36), sex hormone binding globulin (SHBG) (-118.61 nmol/L; 95% CI -174.46, -62.75) and testosterone (0.48 nmol/L; 95% CI 0.32, 0.64) compared with COCP. COCP was inferior for FAI (0.58; 95% CI 0.36, 0.80) and SHBG (-16.61 nmol/L; 95% CI -28.51, -4.71) compared with combination treatment, whereas testosterone did not differ. Metformin lowered insulin (-27.12 pmol/L; 95% CI -40.65, -13.59) and triglycerides (-0.15 mmol/L; 95% CI -0.29, -0.01) compared with COCP. COCP was inferior for insulin (17.03 pmol/L; 95% CI 7.79, 26.26) and insulin resistance (0.44; 95% CI 0.17, 0.70) compared with combination treatment.
CONCLUSIONS: The choice of metformin or COCP treatment should be based on symptoms, noting some biochemical benefits from combination treatment targeting both major endocrine disturbances seen in PCOS (hyperinsulinemia and hyperandrogenism).
摘要：
背景：多囊卵巢综合征（PCOS）影响超过十分之一的女性。
目标：作为2023年国际PCOS指南更新的一部分，联合口服避孕药（COCP）之间的比较，二甲双胍,和联合治疗进行评估。
方法：OvidMedline，Embase,PsycINFO,所有EBM,和CINAHL进行了搜索。
方法：将PCOS患者纳入随机对照试验（RCTs）。
方法：我们计算了人体测量学的平均差和95%CI，新陈代谢，和高雄激素性结果。采用GRADE进行Meta分析和质量评价。
结果：搜索确定了1660篇出版物；包括36篇RCTs。对于多毛症，比较二甲双胍与COCP时没有差异，当比较COCP与二甲双胍和COCP联合治疗时也是如此。二甲双胍的游离雄激素指数（FAI）较差（7.08;95%CI4.81,9.36），与COCP相比，性激素结合球蛋白（SHBG）（-118.61nmol/L；95％CI-174.46，-62.75）和睾丸激素（0.48nmol/L；95％CI0.32，0.64）。与联合治疗相比，FAI（0.58;95％CI0.36，0.80）和SHBG（-16.61nmol/L;95％CI-28.51，-4.71）的COCP较差，而睾酮没有差异。与COCP相比，二甲双胍降低了胰岛素（-27.12pmol/L；95％CI-40.65，-13.59）和甘油三酸酯（-0.15mmol/L；95％CI-0.29，-0.01）。与联合治疗相比，COCP在胰岛素（17.03pmol/L；95％CI7.79，26.26）和胰岛素抵抗（0.44；95％CI0.17，0.70）方面较差。
结论：选择二甲双胍或COCP治疗应根据症状，注意到针对PCOS中两种主要内分泌紊乱(高胰岛素血症和高雄激素血症)的联合治疗的一些生化益处.
目标：作为2023年国际PCOS指南更新的一部分，联合口服避孕药（COCP）之间的比较，二甲双胍,和联合治疗进行评估。
方法：OvidMedline，Embase,PsycINFO,所有EBM,和CINAHL进行了搜索。
方法：将PCOS患者纳入随机对照试验（RCTs）。
方法：我们计算了人体测量学的平均差和95%CI，新陈代谢，和高雄激素性结果。采用GRADE进行Meta分析和质量评价。
结果：搜索确定了1660篇出版物；包括36篇RCTs。对于多毛症，比较二甲双胍与COCP时没有差异，当比较COCP与二甲双胍和COCP联合治疗时也是如此。二甲双胍的游离雄激素指数（FAI）较差（7.08;95%CI4.81,9.36），与COCP相比，性激素结合球蛋白（SHBG）（-118.61nmol/L；95％CI-174.46，-62.75）和睾丸激素（0.48nmol/L；95％CI0.32，0.64）。与联合治疗相比，FAI（0.58;95％CI0.36，0.80）和SHBG（-16.61nmol/L;95％CI-28.51，-4.71）的COCP较差，而睾酮没有差异。与COCP相比，二甲双胍降低了胰岛素（-27.12pmol/L；95％CI-40.65，-13.59）和甘油三酸酯（-0.15mmol/L；95％CI-0.29，-0.01）。与联合治疗相比，COCP在胰岛素（17.03pmol/L；95％CI7.79，26.26）和胰岛素抵抗（0.44；95％CI0.17，0.70）方面较差。
结论：选择二甲双胍或COCP治疗应根据症状，注意到针对PCOS中两种主要内分泌紊乱(高胰岛素血症和高雄激素血症)的联合治疗的一些生化益处.
