Effect of the Combined Oral Contraceptive Pill and/or Metformin in the Management of Polycystic Ovary Syndrome

A Systematic Review With Meta-Analyses

Helena Teede; Eliza C. Tassone; Terhi Piltonen; Jaideep Malhotra; Ben W. Mol; Alexia Peña; Selma F. Witchel; Anju Joham; Veryan McAllister; Daniela Romualdi; Mala Thondan; Michael Costello; Marie L. Misso


Clin Endocrinol. 2019;91(4):479-489. 

In This Article


This extensive systematic review with meta-analyses advances the literature as the most up to date, rigorous synthesis of peer-reviewed literature, which has investigated the effect of the COCP and metformin on clinical, hormonal and metabolic features of PCOS, in both adolescents and adults. It addresses key gaps on the role of these agents in PCOS and the role of metformin. We confirm that COCP therapy for women with PCOS improves hyperandrogenism and menstrual regulation. No type of COCP is adequately proven as superior, and aligned with general population recommendations and side effect profiles, higher dose oestrogen preparations should not be first line and lower dose preparations are recommended. We clarify the role of metformin alone or in combination with COCP showing it is useful for the management of metabolic features of PCOS specifically weight, hormonal and metabolic outcomes, especially in women with PCOS with a BMI ≥ 25 kg/m2. We have directly informed international guideline recommendations and identified research gaps, including the need for additional high-quality RCTs to define optimal type and dose of both COCPs and metformin and to assess their impact on quality of life in PCOS.