title: Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis.
abstract: Polycystic ovarian syndrome (PCOS) is a common disease. There is limited evidence to support various treatment choices. This leads to variable treatment practices.
  
  
  
  To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the use of metformin versus oral contraceptive pills (OCPs) for the treatment of PCOS in adolescents aged 11 to 19 years.
  
  
  
  We performed literature searches through Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials, and gray literature resources, up to January 29, 2015.
  
  
  
  Two reviewers screened titles and abstracts of identified citations, assessed full text eligibility, and extracted information from eligible trials.
  
  
  
  Four RCTs met the inclusion and exclusion criteria. The reviewed evidence came from 170 patients. Overall, OCP treatment resulted in modest improvement in menstrual cycle frequency (weighted mean difference [WMD] = 0.27, P < .01, 95% confidence interval [CI] -0.33 to -0.21) and mild reduction of acne scores (WMD = 0.3, P = .02, 95% CI 0.05 to 0.55). While metformin resulted in greater BMI reduction (WMD = -4.02, P < .01, 95% CI -5.23 to -2.81) it was associated with decreased dysglycemia prevalence (risk ratio: 0.41, P = .02, 95% CI 0.19 to 0.86) and improved total cholesterol and low-density lipoprotein levels. Metformin and OCPs were similar in terms of impact on hirsutism.
  
  
  
  Current evidence is derived from very low to low quality evidence. Therefore, treatment choice should be guided by patient values and preferences while balancing potential side effects. Future high quality RCTs are needed to address several questions for the treatment of adolescents with PCOS.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Pediatrics, Departments of Clinical Epidemiology and Biostatistics, Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia; reem_ah@yahoo.com.
authors.forename: Reem A
authors.initials: RA
authors.lastname: Al Khalifah
authors.affiliation: Departments of Clinical Epidemiology and Biostatistics, Department of Pediatrics, Universidad de Antioquia, Colombia; and.
authors.forename: Ivan D
authors.initials: ID
authors.lastname: Florez
authors.affiliation: Departments of Clinical Epidemiology and Biostatistics, St. George's University of London, Cranmer Terrace, London, United Kingdom.
authors.forename: Brittany
authors.initials: B
authors.lastname: Dennis
authors.affiliation: Departments of Clinical Epidemiology and Biostatistics, Pediatrics and Anesthesia, McMaster University, Hamilton, Canada;
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: Division of Endocrinology and Metabolism, Department of Pediatrics.
authors.forename: Ereny
authors.initials: E
authors.lastname: Bassilious
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy; D000293:Adolescent; D015992:Body Mass Index; D003276:Contraceptives, Oral / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D044882:Glucose Metabolism Disorders / Q000188:drug therapy; D006628:Hirsutism / Q000188:drug therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D008599:Menstruation Disturbances / Q000188:drug therapy; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use*; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral; D007004:Hypoglycemic Agents; D008055:Lipids; D008687:Metformin