Cochrane · systematic review · CD005552
Metformin versus the combined oral contraceptive pill for hirsutism, acne, and menstrual pattern in polycystic ovary syndrome
Fraison, E, Kostova, E, Moran, LJ, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Gynaecology and FertilityAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
36
current version
GRADE rated
19
No studies
17
Included studies
NR
No studies 17 · 47.2%Ungraded 0 · 0%Very low 9 · 25%Low 10 · 27.8%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Metformin compared to oral contraceptive pill (OCP) for hirsutism, acne, and menstrual pattern in adult women with polycystic ovary syndrome (PCOS)
Population: adult women with PCOS
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Hirsutism ‐ Clinical F‐G score Metformin vs oral contraceptive pill (OCP) | no estimate extracted | 3 studies · 134 participants | Very low Downgraded: risk of bias, inconsistency |
Adverse events ‐ Severe Metformin vs oral contraceptive pill (OCP) | OR 6.42 [2.98, 13.84] | 11 studies · 602 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events ‐ Minor Metformin vs oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
Improved menstrual pattern Metformin vs oral contraceptive pill (OCP) | no estimate extracted | 2 studies · 153 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Acne ‐ Visual analogue scale Metformin vs oral contraceptive pill (OCP) | no estimate extracted | 1 study · 34 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
BMI (kg/m2) Metformin vs oral contraceptive pill (OCP) | no estimate extracted | 9 studies · 451 participants | Very low Downgraded: risk of bias |
Metformin compared to metformin combined with oral contraceptive pill (OCP) for hirsutism, acne, and menstrual pattern in adult women with polycystic ovary syndrome (PCOS)
Population: adult women with PCOS
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Hirsutism ‐ Clinical F‐G score Metformin vs metformin combined with oral contraceptive pill (OCP) | no estimate extracted | 3 studies · 135 participants | Low Downgraded: risk of bias, imprecision |
Adverse events ‐ Severe Metformin vs metformin combined with oral contraceptive pill (OCP) | OR 0.74 [0.21, 2.53] | 3 studies · 171 participants | Low Downgraded: risk of bias, imprecision |
Adverse events ‐ Minor Metformin vs metformin combined with oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
Improved menstrual pattern Metformin vs metformin combined with oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
Acne ‐ Visual analogue scale/Clinical acne score Metformin vs metformin combined with oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
BMI (kg/m2) Metformin vs metformin combined with oral contraceptive pill (OCP) | no estimate extracted | 5 studies · 199 participants | Low Downgraded: risk of bias, imprecision |
Oral contraceptive pill (OCP) compared to metformin combined with OCP for hirsutism, acne, and menstrual pattern in adult women with polycystic ovary syndrome (PCOS)
Population: aAdult women with PCOS
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Hirsutism ‐ Clinical F‐G score Oral contraceptive pill (OCP) vs metformin combined with OCP | no estimate extracted | 6 studies · 389 participants | Low Downgraded: risk of bias, imprecision |
Adverse events ‐ Severe Oral contraceptive pill (OCP) vs metformin combined with OCP | OR 0.2 [0.06, 0.72] | 5 studies · 228 participants | Low Downgraded: risk of bias, imprecision |
Adverse events ‐ Minor Oral contraceptive pill (OCP) vs metformin combined with OCP | OR 0.06 [0.01, 0.44] | 2 studies · 98 participants | Low Downgraded: risk of bias, imprecision |
Improved menstrual pattern Oral contraceptive pill (OCP) vs metformin combined with OCP | no estimate extracted | NR | No studies |
Acne ‐ Clinical acne score Oral contraceptive pill (OCP) vs metformin combined with OCP | no estimate extracted | 1 study · 82 participants | Low Downgraded: imprecision |
BMI (kg/m2) Oral contraceptive pill (OCP) vs metformin combined with OCP | no estimate extracted | 13 studies · 661 participants | Very low Downgraded: risk of bias, inconsistency |
Metformin compared to oral contraceptive pill (OCP) for hirsutism, acne, and menstrual pattern in adolescent women with polycystic ovary syndrome (PCOS)
Population: adolescent women with PCOS
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Hirsutism ‐ Clinical F‐G score Metformin vs oral contraceptive pill (OCP) | no estimate extracted | 1 study · 16 participants | Very low Downgraded: risk of bias, imprecision |
Adverse event ‐ Severe Metformin vs oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
Adverse event ‐ Minor Metformin vs oral contraceptive pill (OCP) | OR 11.67 [0.53, 258.56] | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision |
Improved menstrual pattern Metformin vs oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
Acne ‐ Visual analogue scale or Clinical acne score Metformin vs oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
BMI (kg/m2) Metformin vs oral contraceptive pill (OCP) | no estimate extracted | 3 studies · 69 participants | Very low Downgraded: risk of bias, imprecision |
Metformin compared to metformin combined with oral contraceptive pill (OCP) for hirsutism, acne and menstrual pattern in adolescent women with polycystic ovary syndrome (PCOS)
Population: adolescent women with PCOS
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Hirsutism ‐ Clinical F‐G score Metformin vs metformin combined with oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
Adverse event ‐ Severe Metformin vs metformin combined with oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
Adverse event ‐ Minor Metformin vs metformin combined with oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
Improved menstrual pattern Metformin vs metformin combined with oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
Acne ‐ Visual analogue scale or Clinical acne score Metformin vs metformin combined with oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
BMI (kg/m2) Metformin vs metformin combined with oral contraceptive pill (OCP) | no estimate extracted | NR | No studies |
Oral contraceptive pill (OCP) compared to metformin combined with OCP for hirsutism, acne, and menstrual pattern in adolescent women with polycystic ovary syndrome PCOS
Population: adolescent women with PCOS
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Hirsutism ‐ Clinical F‐G score Oral contraceptive pill (OCP) vs metformin combined with OCP | no estimate extracted | 1 study · 32 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events ‐ Severe Oral contraceptive pill (OCP) vs metformin combined with OCP | OR 1 [0.06, 17.33] | 1 study · 36 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events ‐ Minor Oral contraceptive pill (OCP) vs metformin combined with OCP | no estimate extracted | NR | No studies |
Improved menstrual pattern Oral contraceptive pill (OCP) vs metformin combined with OCP | no estimate extracted | NR | No studies |
Acne ‐ Visual analogue scale or Clinical acne score Oral contraceptive pill (OCP) vs metformin combined with OCP | no estimate extracted | NR | No studies |
BMI (kg/m2) Oral contraceptive pill (OCP) vs metformin combined with OCP | no estimate extracted | 1 study · 32 participants | Very low Downgraded: risk of bias, imprecision |