Update on the Therapeutic Role of Metformin in the Management of Polycystic Ovary Syndrome: Effects on Pathophysiologic Process and Fertility Outcomes

    February 2025 in “ Women s Health ”
    K. Brand, Ulrike Gottwald‐Hostalek, Aimee Andag‐Silva
    TLDR Metformin helps manage PCOS by improving fertility and is safe for pregnancy, especially when combined with certain treatments.
    Metformin is effective in managing polycystic ovary syndrome (PCOS) by improving insulin resistance, which enhances ovulation, pregnancy, and live birth rates. It is particularly beneficial when combined with clomifene citrate, especially in clomifene-resistant cases, but does not improve outcomes with letrozole. Continuing metformin through the first trimester may reduce miscarriage rates and is generally safe for both mother and child. It also aids in weight management, reduces cardiometabolic risks, and improves psychological well-being. Metformin is a viable first-line treatment for infertility related to anovulatory PCOS, especially in non-obese women, and serves as an adjunctive therapy in assisted reproduction technology (ART). However, potential risks like vitamin B12 deficiency and lactic acidosis with long-term use require careful monitoring.
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