Efficacy of Metformin-Cabergoline compared to Metformin Monotherapy for Management of PCOS with Hyperprolactinemia– A Systematic Review and Meta-analysis

Background: Metformin plays a major part in the treatment of polycystic ovarian syndrome (PCOS). Trials are being conducted to compare the effectiveness of combination of metformin with cabergoline in the treatment of hyperprolactinemia and polycystic ovarian syndrome. Objectives: The purpose of this study is to compare the effectiveness of metformin monotherapy and combination therapy with cabergoline vs metformin for the management of PCOS with hyperprolactinemia. Method: ology An extensive search up until January 23rd, 2024 of electronic databases (PubMed, Registry of Controlled Clinical Trials, Web of Sciences, SCOPUS) to find pertinent studies. An analysis was conducted with both observational data and randomized clinical trials (RCTs). To compute the standard mean difference (SMD), weighted mean difference (WMD), odds ratio (OR), and 95% confidence interval (CI), RevMan (v5.3) was utilized. Primary outcomes that were assessed included body-mass index (BMI), regular menstruation, weight change, prolactin, testosterone, and dehydroepiandrosterone-sulfate (DHEAS) levels. Results: Three randomized controlled trials and one observational study, taking a total patient population of n = 535, were part of our final analysis. Prolactin (SMD = -3.23 95%Cl:(-4.90, -1.55)) and DHEAS levels (SMD = -0.27 95%Cl:(-0.52, -0.01)) were significantly lower in the metformin and cabergoline combination therapy group; monthly regularity was also significantly higher (OR = 3.07 95%Cl:(2.09, 4.51)). Statistically, there was no significant difference in weight, BMI, or testosterone levels. Conclusions: In the treatment of PCOS, the combination of metformin and cabergoline significantly lowers prolactin levels and encourages regular menstrual cycles. Although metformin has the potential to suppress testosterone levels, more investigation is required to determine how combination therapy affect DHEAS and testosterone levels. It's interesting to note that while neither intervention had a substantial impact on weight or BMI, metformin and cabergoline combination therapy outperformed metformin monotherapy in terms of supporting regular menstrual cycles. Customized therapy approaches are essential, and large-scale trials involving a variety of groups are required to comprehend the safety and effectiveness of treatments.