Effect of Metformin Treatment on Gonadotropin Levels in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of 51 Randomised Controlled Trials
Abstract
ABSTRACT Aims This study aimed to explore the impact of metformin on gonadotropin levels in women with polycystic ovary syndrome (PCOS) based on a meta‐analysis of randomised controlled trials (RCTs). Methods The search process was performed in PubMed, Scopus, Web of Science, ClinicalTrials.gov and Google Scholar. RCTs were eligible for meta‐analysis if they had a parallel or crossover design and reported gonadotropin levels before and after metformin treatment. A random‐effects model and the generic inverse variance method were used for meta‐analysis. Results The meta‐analysis of 51 RCTs, 48 of which included only and 2 included predominantly women with PCOS, showed that metformin treatment did not affect FSH (WMD: −0.22 IU/L, 95% CI: −0.54, 0.11, p = 0.19, I 2 = 84%) or LH (WMD: 0.11 IU/L, 95% CI: −0.38, 0.60, p = 0.66, I 2 = 75%), but it significantly increased the LH/FSH ratio (WMD: 0.24%, 95% CI: 0.06, 0.43, p = 0.01, I 2 = 93%). Additionally, the effect size was sensitive to one study for FSH, LH and LH/FSH ratio following the sensitivity analysis. Conclusion Our meta‐analysis, the largest one conducted to date, indicates that metformin does not significantly affect circulating gonadotropin levels in reproductive‐age women with PCOS.
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