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Impact of Combined Hormonal Contraceptives and Metformin on Metabolic Syndrome in Women with Hyperandrogenic Polycystic Ovary Syndrome and Obesity: The COMET-PCOS Randomized Clinical Trial
For decades, women with polycystic ovary syndrome were treated with combined oral contraceptive pills, but in recent years metformin is also commonly prescribed. However, strong evidence for a specific treatment is lacking. In this multi-center randomized clinical trial, Anuja Dokras and colleagues compare the effects of oral contraceptive pills, metformin, and a combination of both on metabolic syndrome prevalence in patients with high-risk hyperandrogenic polycystic ovary syndrome and obesity. 240 participants with PCOS and BMI between 25-48 were randomized 1:1:1 to 24 weeks of oral contraceptive pills, metformin, or both. They found no significant differences in metabolic syndrome between these groups.
Image Credit: Karola G via Pexels
Citation: (2026) PLoS Medicine Issue Image | Vol. 22(12) January 2026. PLoS Med 22(12): ev22.i12. https://doi.org/10.1371/image.pmed.v22.i12
Published: January 12, 2026
Copyright: © 2026 . This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
For decades, women with polycystic ovary syndrome were treated with combined oral contraceptive pills, but in recent years metformin is also commonly prescribed. However, strong evidence for a specific treatment is lacking. In this multi-center randomized clinical trial, Anuja Dokras and colleagues compare the effects of oral contraceptive pills, metformin, and a combination of both on metabolic syndrome prevalence in patients with high-risk hyperandrogenic polycystic ovary syndrome and obesity. 240 participants with PCOS and BMI between 25-48 were randomized 1:1:1 to 24 weeks of oral contraceptive pills, metformin, or both. They found no significant differences in metabolic syndrome between these groups.
Image Credit: Karola G via Pexels