Revisiting Metformin in the Management of Polycystic Ovary Syndrome (PCOS).

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder that significantly affects both obese and non-obese women of reproductive age. Besides genetic and epigenetic factors, obesity and insulin resistance (IR) play a key role in the pathogenesis of PCOS, contributing to its endocrine, reproductive, and metabolic manifestations. Even though metformin remains a well-established treatment in the management of PCOS, emerging therapies and integrative approaches warrant comparison. This narrative review aims to understand the pathophysiology of PCOS and compare the role of metformin with that of new emerging therapies, including sodium-glucose cotransporter-2 (SGLT-2) inhibitors, oral contraceptive pills (OCPs), inositol supplements, and lifestyle modifications, thereby empowering clinicians to provide personalized medicine based on each patient's unique presentation. This review explores the safety, efficacy, and clinical outcomes of these interventions on weight reduction, hormonal balance, menstrual regularity, and metabolic outcomes in both obese and non-obese women with PCOS.