What are the recommended pharmacological treatments for managing insulin resistance in patients with PCOS?

Recommended pharmacological treatments for managing insulin resistance in patients with polycystic ovary syndrome (PCOS) include:

• Metformin: Metformin is used off-label in PCOS to improve insulin resistance, particularly in women with a BMI ≥ 25 kg/m2, those with diabetes risk factors, impaired glucose tolerance, or belonging to high-risk ethnic groups. It may be used alone or in combination with combined oral contraceptives (COCs) to manage metabolic and weight outcomes. Metformin should be considered especially when lifestyle interventions alone are insufficient. Patients should be informed about its off-label use, potential gastrointestinal side effects, and the need for monitoring vitamin B12 levels. Long-term use appears safe based on other populations, but ongoing need should be reviewed regularly ¹.
• Combined Oral Contraceptives (COCs): While primarily used to manage hyperandrogenism and menstrual irregularities in PCOS, COCs alone are not specifically targeted at insulin resistance but may be combined with metformin to address metabolic features when lifestyle changes and COCs alone do not achieve desired outcomes ¹.

Lifestyle management including healthy eating, regular physical activity, and weight loss remains the first-line treatment and should precede or accompany pharmacological treatment to reduce insulin resistance ¹.