GLP-1 RECEPTOR AGONISTS VERSUS METFORMIN IN POLYCYSTIC OVARY SYNDROME: METABOLIC BENEFITS, REPRODUCTIVE OUTCOMES AND THE EVIDENCE GAP IN LEAN PCOS
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5563Keywords:
PCOS, Metformin, BMI, GLP-1, Female Fertility, Physical Activity, Reproductive Health, Lifestyle Factors, Exercise, Anti-obesity pharmacotherapy, Lean PCOS, Adolescent ObesityAbstract
Polycystic ovary syndrome (PCOS) is one of the most frequently diagnosed disorders that affects many women of reproductive age and is linked to both metabolic and reproductive problems. Metformin has been used for many years as a standard treatment for insulin resistance in PCOS, while glucagon-like peptide-1 (GLP-1) receptor agonists have recently
gained interest because of their stronger effects on body weight and metabolism. The aim of this review was to compare the effects of GLP-1 receptor agonists and metformin in women with PCOS, with special attention to the lack of data in lean PCOS.
Most studies show that GLP-1 receptor agonists lead to greater weight loss and larger reductions in body mass index, waist circumference, and insulin resistance compared with metformin, especially in women with overweight or obesity. However, when it comes to reproductive outcomes such as ovulation, menstrual regularity, or androgen levels, neither treatment clearly shows better results than the other. An important limitation of current research is that most studies include mainly overweight patients, while data on lean PCOS are still limited.
Overall, GLP-1 receptor agonists seem to offer stronger metabolic benefits, while metformin remains a practical and commonly used first-line treatment, particularly in lean patients. More studies focusing on different PCOS phenotypes, especially lean PCOS, are needed to better guide treatment decisions.
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Copyright (c) 2026 Nicole Bulińska, Bogusław Pabis , Anna Maria Kowalska , Aleksandra Anna Kuls , Aleksandra Zofia Sobol , Zofia Sinczak, Martyna Kadłubańska , Justyna Maria Wiktorowicz , Sonia Zembrzuska , Stanisław Bajerski
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