OBJECTIVES: Polycystic ovary syndrome (PCOS), a prevalent endocrine disorder affecting women’s quality of life (QoL), is increasingly being managed with metformin. The objective of this systematic literature review (SLR) is to evaluate the impact of metformin on QoL in women with PCOS.

METHODS: Key biomedical databases (Embase® and Medline®) were searched from database inception to May 2024 to identify randomized controlled trials (RCTs) that met the prespecified eligibility criteria. Bibliographic searching was conducted to supplement the evidence base.

RESULTS: A total of 256 publications were screened, of which five RCTs assessing the impact of metformin on the QoL were included. The QoL scales utilized across the included evidence were the Polycystic Ovary Syndrome Questionnaire (PCOSQ, n=2), Short Form-36 (SF-36, n=2), Polycystic ovarian syndrome-Visual Analog Score1-6 (PCOS-VAS1-6, n=1), and Rotterdam Symptom Checklist (RSCL, n=1). Metformin-based combination treatment was assessed in three studies, while two assessed metformin monotherapy. At 6 months, compared to metformin monotherapy, two studies reported significantly higher PCOSQ scores among women treated with either combination of metformin + myoinositol + D‐chiro‐inositol (p<0.001) or N-acetylcysteine (p<0.05). Further, in another study, both oral contraceptives (OCP) and combination of metformin + oral contraceptives (MOCP) reported decline in PCOS-VAS1 (facial hair) scores at 12 months which indicated better QoL compared to metformin monotherapy, however, the difference in PCOS-VAS2-6 scores were comparable between the three intervention groups. Conversely, combination of metformin + clomifene citrate (CC) patients reported poor QoL as indicted with higher RSCL scores at 16 weeks compared to CC group. SF-36 scores were similar across metformin monotherapy, myoinositol, OCP, and MOCP treatment groups indicating comparable QoL.

CONCLUSIONS: The findings of this SLR suggest that metformin-based combination therapies can improve QoL in women with PCOS, but further research is needed to explore their full potential in clinical settings due to limited evidence.