Summary
Background: Polycystic ovary syndrome (PCOS) affects up to 13% women and is
associated
with significant complications. The quality of evidence supporting the
recommendations
on treatment of nonreproductive outcomes in PCOS is unknown.
Objective: To summarize and appraise the methodological quality of systematic
reviews
and meta-analyses
evaluating pharmacological and surgical treatments for
nonreproductive outcomes in PCOS.
Methods: A literature search from MEDLINE, EMBASE, CINAHL PLUS and
PROSPERO was performed from inception until 15th of September 2017. Article
selection,
data extraction and quality appraisal of included reviews were performed
in duplicate. A narrative synthesis of the findings was conducted.
Results: This overview included 31 reviews. The quality was low for 7 (23%), moderate
for sixteen (52%) and high for 8 reviews (26%). Two reviews assessed psychological
outcomes. Metformin improved anthropometric (7 of 10 reviews), metabolic (4 of
14 reviews) and endocrine outcomes (3 of twelve reviews). Thiazolidinediones improved
metabolic (2 of 5 reviews) and endocrine outcomes (one of 5 reviews) but
worsened weight gain (5 of 5 reviews). Combined oral contraceptive pill (COCP) improved
clinical hyperandrogenism (2 of 2 reviews). Statins improved lipid profile (3 of
3 reviews) and testosterone level (2 of 3 reviews). There was no conclusive evidence
from included systematic reviews regarding the use of other interventions.
Conclusions: There is reliable evidence regarding the use of metformin for anthropometric
outcomes and COCPs for hyperandrogenism in women with PCOS but not for
other interventions. There is significant gap in knowledge regarding the management
of psychological outcomes in women with PCOS which needs further evaluation.