{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:33:38Z","timestamp":1790069618301,"version":"4.0.1"},"reference-count":77,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Cantebrury Aho Hinetori PhD scholarship"},{"DOI":"10.13039\/100008414","name":"University of Canterbury","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008414","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Phys Eng Sci Med"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Polycystic ovary syndrome (PCOS) is a heterogenous condition that is estimated to effect up to 21% of reproductive aged people with ovaries. In previous work, a dataset of PCOS features was derived from approximately 100,000 PCOS subreddit users via machine learning. In this study, an exploration of treatment response within the PCOS subreddit was undertaken with the derived dataset. The treatment or symptom features in the dataset had sentiment labels indicating when a treatment was perceived to improve or worsen a condition or symptom. When different features were mentioned within two sentences of each other without conflicting sentiment, it could be assumed that they were related. This assumption allowed for a broad analysis of the perceived effect of popular treatments on the most frequently mentioned symptoms. In general, lifestyle changes and supplements were the most positively regarded, while contraceptives were frequently associated with considerable negative sentiment. For PCOS weight loss, unspecified dieting (RR 5.19, 95% CI 3.28\u20138.19, n\u2009=\u200999) and intermittent fasting (RR 33.50, 95% CI 8.54\u2013131.34, n\u2009=\u200969) were the most successful interventions. Inositol was associated with a large range of favourable outcomes and was one of the few treatments associated with improved mental health [depression (RR 4.25, 95% CI 1.72\u201310.51, n\u2009=\u200921), anxiety (RR 5.83, 95% CI 2.76\u201312.35, n\u2009=\u200941) and mood issues (RR 25.00, 95% CI 3.65\u2013171.10, n\u2009=\u200926)]. Combined oral contraceptive pills as a whole were strongly associated with adverse effects such as worsening depression (RR 0.06, 95% CI 0.02\u20130.25, n\u2009=\u200933), anxiety (RR 0.10, 95% CI 0.03\u20130.36, n\u2009=\u200923), fatigue (RR 0, n\u2009=\u200945) and low libido (RR 0.03, 95% CI 0.01\u20130.24, n\u2009=\u200930). However, combined contraceptives with anti-androgenic progestins were associated with more favourable experiences. This study demonstrates the utility of machine learning to derive measurable patient experience data from an internet forum. While patient experience data derived using machine learning is not a substitute for traditional clinical trials, it is useful for mass validation and hypothesis generation. This paper may serve as the first exploration into this category of clinical internet forum research.<\/jats:p>","DOI":"10.1007\/s13246-025-01539-9","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T11:24:41Z","timestamp":1744629881000},"page":"723-741","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["What do users in a polycystic ovary syndrome (PCOS) forum think about the treatments they tried: Analysing treatment sentiment using machine learning"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3701-1048","authenticated-orcid":false,"given":"Rebecca H. K.","family":"Emanuel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1661-2573","authenticated-orcid":false,"given":"Paul D.","family":"Docherty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0069-7402","authenticated-orcid":false,"given":"Helen","family":"Lunt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0309-532X","authenticated-orcid":false,"given":"Rebecca E.","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"issue":"6","key":"1539_CR1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003132","volume":"17","author":"M Dapas","year":"2020","unstructured":"Dapas M et al (2020) Distinct subtypes of polycystic ovary syndrome with novel genetic associations: An unsupervised, phenotypic clustering analysis. PLoS Med 17(6):e1003132. https:\/\/doi.org\/10.1371\/journal.pmed.1003132","journal-title":"PLoS Med"},{"issue":"11","key":"1539_CR2","doi-asserted-by":"publisher","first-page":"4325","DOI":"10.1210\/jc.2013-2040","volume":"98","author":"A Dunaif","year":"2013","unstructured":"Dunaif A, Fauser BCJM (2013) Renaming PCOS\u2014A Two-State Solution. J Clin Endocrinol Metab 98(11):4325\u20134328. https:\/\/doi.org\/10.1210\/jc.2013-2040","journal-title":"J Clin Endocrinol Metab"},{"issue":"10","key":"1539_CR3","doi-asserted-by":"publisher","first-page":"2447","DOI":"10.1210\/clinem\/dgad463","volume":"108","author":"HJ Teede","year":"2023","unstructured":"Teede HJ et al (2023) Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab 108(10):2447\u20132469. https:\/\/doi.org\/10.1210\/clinem\/dgad463","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"1539_CR4","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1210\/er.2015-1104","volume":"37","author":"RL Rosenfield","year":"2016","unstructured":"Rosenfield RL, Ehrmann DA (2016) The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocr Rev 37(5):467\u2013520. https:\/\/doi.org\/10.1210\/er.2015-1104","journal-title":"Endocr Rev"},{"issue":"3","key":"1539_CR5","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1093\/humrep\/des463","volume":"28","author":"NK Stepto","year":"2013","unstructured":"Stepto NK et al (2013) Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic\u2013hyperinsulaemic clamp. Hum Reprod 28(3):777\u2013784. https:\/\/doi.org\/10.1093\/humrep\/des463","journal-title":"Hum Reprod"},{"issue":"4","key":"1539_CR6","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1093\/humupd\/dmy007","volume":"24","author":"NS Kakoly","year":"2018","unstructured":"Kakoly NS et al (2018) Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression. Hum Reprod Update 24(4):455\u2013467. https:\/\/doi.org\/10.1093\/humupd\/dmy007","journal-title":"Hum Reprod Update"},{"key":"1539_CR7","doi-asserted-by":"publisher","unstructured":"S. Palomba, M. A. deWilde, A. Falbo, M. P. H. Koster, G. B. La Sala, B. C. J. M. Fauser. (2015). Reply Polycystic ovary syndrome and pregnancy. Human Reproduction Update. 22(2): 278\u2013279. https:\/\/doi.org\/10.1093\/humupd\/dmv052.","DOI":"10.1093\/humupd\/dmv052"},{"issue":"9","key":"1539_CR8","doi-asserted-by":"publisher","first-page":"2421","DOI":"10.1093\/humrep\/deab181","volume":"36","author":"S Palomba","year":"2021","unstructured":"Palomba S (2021) Is fertility reduced in ovulatory women with polycystic ovary syndrome? An opinion paper. Hum Reprod 36(9):2421\u20132428. https:\/\/doi.org\/10.1093\/humrep\/deab181","journal-title":"Hum Reprod"},{"issue":"3","key":"1539_CR9","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1210\/jc.2014-3886","volume":"100","author":"R Hart","year":"2015","unstructured":"Hart R, Doherty DA (2015) The Potential Implications of a PCOS Diagnosis on a Woman\u2019s Long-Term Health Using Data Linkage. J Clin Endocrinol Metab 100(3):911\u2013919. https:\/\/doi.org\/10.1210\/jc.2014-3886","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"1539_CR10","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1093\/humrep\/dex044","volume":"32","author":"LG Cooney","year":"2017","unstructured":"Cooney LG, Lee I, Sammel MD, Dokras A (2017) High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 32(5):1075\u20131091. https:\/\/doi.org\/10.1093\/humrep\/dex044","journal-title":"Hum Reprod"},{"key":"1539_CR11","doi-asserted-by":"publisher","unstructured":"T. Copp et al. (2022). The challenges with managing polycystic ovary syndrome: A qualitative study of women\u2019s and clinicians\u2019 experiences. Patient Education and Counseling. 105(3): 719\u2013725. https:\/\/doi.org\/10.1016\/j.pec.2021.05.038.","DOI":"10.1016\/j.pec.2021.05.038"},{"key":"1539_CR12","doi-asserted-by":"publisher","unstructured":"E. S. Sills, M. Perloe, M. J. Tucker, C. R. Kaplan, M. G. Genton, and G. L. Schattman, (2001). Diagnostic and treatment characteristics of polycystic ovary syndrome: descriptive measurements of patient perception and awareness from 657 confidential self-reports. BMC Women\u2019s Health, 1(1): 3. https:\/\/doi.org\/10.1186\/1472-6874-1-3.","DOI":"10.1186\/1472-6874-1-3"},{"key":"1539_CR13","doi-asserted-by":"publisher","unstructured":"B. Ozgen Saydam and B. O. Yildiz, (2015). Weight management strategies for patients with PCOS: current perspectives. Expert Rev Endocrinol Metabol. 16(2): 49\u201362. https:\/\/doi.org\/10.1080\/17446651.2021.1896966.","DOI":"10.1080\/17446651.2021.1896966"},{"key":"1539_CR14","doi-asserted-by":"publisher","unstructured":"S. Abdolahian et al., (2020). Effect of lifestyle modifications on anthropometric, clinical, and biochemical parameters in adolescent girls with polycystic ovary syndrome a systematic review and meta-analysis, (in eng), BMC Endocr Disord, 20(1): 71. https:\/\/doi.org\/10.1186\/s12902-020-00552-1.","DOI":"10.1186\/s12902-020-00552-1"},{"issue":"1","key":"1539_CR15","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.1152\/ajpendo.00667.2010","volume":"301","author":"N Raja-Khan","year":"2011","unstructured":"Raja-Khan N, Stener-Victorin E, Wu X, Legro RS (2011) The physiological basis of complementary and alternative medicines for polycystic ovary syndrome. Amr J Physiol-Endocrinol Metabol 301(1):E1\u2013E10. https:\/\/doi.org\/10.1152\/ajpendo.00667.2010","journal-title":"Amr J Physiol-Endocrinol Metabol"},{"key":"1539_CR16","doi-asserted-by":"publisher","first-page":"2703","DOI":"10.2147\/ndt.S385014","volume":"18","author":"M Sukhapure","year":"2022","unstructured":"Sukhapure M, Eggleston K, Fenton A, Frampton C, Porter RJ, Douglas KM (2022) \u201cChanges in Mood, Anxiety, and Cognition with Polycystic Ovary Syndrome Treatment: A Longitudinal, Naturalistic Study,\u201d (in eng). Neuropsychiatr Dis Treat 18:2703\u20132712. https:\/\/doi.org\/10.2147\/ndt.S385014","journal-title":"Neuropsychiatr Dis Treat"},{"key":"1539_CR17","doi-asserted-by":"publisher","unstructured":"R. H. K. Emanuel, P. D. Docherty, H. Lunt, and R. E. Campbell, (2023). Comparing Literature- and Subreddit-Derived Laboratory Values in Polycystic Ovary Syndrome (PCOS) Validation of Clinical Data Posted on PCOS Reddit Forums. JMIR Form Res. 7, e44810. https:\/\/doi.org\/10.2196\/44810.","DOI":"10.2196\/44810"},{"key":"1539_CR18","doi-asserted-by":"publisher","unstructured":"R. H. K. Emanuel, P. D. Docherty, H. Lunt, R. Murray, and R. E. Campbell, (2024). \"Clustering polycystic ovary syndrome laboratory results extracted from a large internet forum with machine learning, Intelligence-Based Medicine. 9, 100135. https:\/\/doi.org\/10.1016\/j.ibmed.2024.100135.","DOI":"10.1016\/j.ibmed.2024.100135"},{"issue":"24","key":"1539_CR19","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.ifacol.2024.11.005","volume":"58","author":"RHK Emanuel","year":"2024","unstructured":"Emanuel RHK, Docherty PD, Lunt H, Campbell RE, M\u00f6ller K (2024) Extracting Features and Sentiment from Text Posts and Comments Relating to Polycystic Ovary Syndrome. IFAC-PapersOnLine 58(24):19\u201324. https:\/\/doi.org\/10.1016\/j.ifacol.2024.11.005","journal-title":"IFAC-PapersOnLine"},{"key":"1539_CR20","unstructured":"Reddit. \"PCOS.\" https:\/\/www.reddit.com\/r\/PCOS\/ (accessed 2021)."},{"key":"1539_CR21","doi-asserted-by":"crossref","unstructured":"J. Baumgartner, S. Zannettou, B. Keegan, M. Squire, and J. Blackburn, \"The Pushshift Reddit Dataset,\" Proceedings of the International AAAI Conference on Web and Social Media, vol. 14, no. 1, pp. 830\u2013839, 05\/26 2020. [Online]. Available: https:\/\/ojs.aaai.org\/index.php\/ICWSM\/article\/view\/7347.","DOI":"10.1609\/icwsm.v14i1.7347"},{"key":"1539_CR22","doi-asserted-by":"publisher","unstructured":"C. Fiesler, M. Zimmer, N. Proferes, S. Gilbert, and N. Jones, (2024). Remember the Human: A Systematic Review of Ethical Considerations in Reddit Research,\" Proc. ACM Hum.-Comput. Interact., 8, no. GROUP, p. Article 5, https:\/\/doi.org\/10.1145\/3633070.","DOI":"10.1145\/3633070"},{"key":"1539_CR23","doi-asserted-by":"publisher","unstructured":"M. Gliniecka, \"The Ethics of Publicly Available Data Research: A Situated Ethics Framework for Reddit,\" Social Media + Society, vol. 9, no. 3, p. 20563051231192021, 2023, https:\/\/doi.org\/10.1177\/20563051231192021.","DOI":"10.1177\/20563051231192021"},{"issue":"3","key":"1539_CR24","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1177\/17470161231210542","volume":"20","author":"T Rocha-Silva","year":"2024","unstructured":"Rocha-Silva T, Nogueira C, Rodrigues L (2024) Passive data collection on Reddit: a practical approach. Research Ethics 20(3):453\u2013470. https:\/\/doi.org\/10.1177\/17470161231210542","journal-title":"Research Ethics"},{"key":"1539_CR25","doi-asserted-by":"publisher","unstructured":"N. Norman Adams, (2024). \u2018Scraping\u2019 Reddit posts for academic research? Addressing some blurred lines of consent in growing internet-based research trend during the time of Covid-19,\" International Journal of Social Research Methodology, 27(1): 47\u201362. https:\/\/doi.org\/10.1080\/13645579.2022.2111816.","DOI":"10.1080\/13645579.2022.2111816"},{"key":"1539_CR26","unstructured":"R. Bhat, L. Crawford, and N. Hong, \"A Post a Day Keeps the Doctor Away: Sharing Personal Information on Self-Diagnosis Platforms,\" arXiv, p. 2412.10709, 2024, https:\/\/arxiv.org\/abs\/2412.10709."},{"key":"1539_CR27","doi-asserted-by":"publisher","unstructured":"M. Skrzelowski, A. Brookhaus, L. Shea, and D. Berlau, (2021). \"Melatonin Use in Pediatrics: Evaluating the Discrepancy in Evidence Based on Country and Regulations Regarding Production,\" The Journal of Pediatric Pharmacology and Therapeutics, 26: 4\u201320. https:\/\/doi.org\/10.5863\/1551-6776-26.1.4.","DOI":"10.5863\/1551-6776-26.1.4"},{"key":"1539_CR28","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s40200-015-0154-1","volume":"14","author":"JE Clark","year":"2015","unstructured":"Clark JE (2015) \u201cDiet, exercise or diet with exercise: comparing the effectiveness of treatment options for weight-loss and changes in fitness for adults (18\u201365 years old) who are overfat, or obese; systematic review and meta-analysis,\u201d (in eng). J Diabetes Metab Disord 14:31. https:\/\/doi.org\/10.1186\/s40200-015-0154-1","journal-title":"J Diabetes Metab Disord"},{"key":"1539_CR29","doi-asserted-by":"publisher","unstructured":"A. Agrawal, R. Mahey, G. Kachhawa, R. Khadgawat, P. Vanamail, and A. Kriplani, (2019). Comparison of metformin plus myoinositol vs metformin alone in PCOS women undergoing ovulation induction cycles: randomized controlled trial,\" Gynecological Endocrinology, 35(6): 511\u2013514, https:\/\/doi.org\/10.1080\/09513590.2018.1549656.","DOI":"10.1080\/09513590.2018.1549656"},{"key":"1539_CR30","doi-asserted-by":"publisher","unstructured":"C. Li, C. Xing, J. Zhang, H. Zhao, W. Shi, and B. He, \"Eight-hour time-restricted feeding improves endocrine and metabolic profiles in women with\u00a0anovulatory polycystic ovary syndrome,\" (in eng), J Transl Med, vol. 19, no. 1, p. 148, Apr 13 2021, https:\/\/doi.org\/10.1186\/s12967-021-02817-2.","DOI":"10.1186\/s12967-021-02817-2"},{"key":"1539_CR31","doi-asserted-by":"publisher","unstructured":"B. S. Feyzioglu, C. M. G\u00fcven, and Z. Avul, \"Eight-Hour Time-Restricted Feeding: A Strong Candidate Diet Protocol for First-Line Therapy in Polycystic Ovary Syndrome,\" (in eng), Nutrients, vol. 15, no. 10, May 10 2023, https:\/\/doi.org\/10.3390\/nu15102260.","DOI":"10.3390\/nu15102260"},{"key":"1539_CR32","doi-asserted-by":"publisher","unstructured":"S. Cienfuegos et al., (2022). \"Effect of Intermittent Fasting on Reproductive Hormone Levels in Females and Males: A Review of Human Trials,\" (in eng), Nutrients, https:\/\/doi.org\/10.3390\/nu14112343.","DOI":"10.3390\/nu14112343"},{"issue":"10","key":"1539_CR33","doi-asserted-by":"publisher","first-page":"3346","DOI":"10.1210\/clinem\/dgaa425","volume":"105","author":"Y Shang","year":"2020","unstructured":"Shang Y, Zhou H, Hu M, Feng H (2020) Effect of Diet on Insulin Resistance in Polycystic Ovary Syndrome. J Clin Endocrinol Metab 105(10):3346\u20133360. https:\/\/doi.org\/10.1210\/clinem\/dgaa425","journal-title":"J Clin Endocrinol Metab"},{"key":"1539_CR34","doi-asserted-by":"publisher","unstructured":"C. R. Juhl, H. K. M. Bergholdt, I. M. Miller, G. B. E. Jemec, J. K. Kanters, and C. Ellervik, (2018). Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-Analysis of 78,529 Children, Adolescents, and Young Adults, (in eng), Nutrients, https:\/\/doi.org\/10.3390\/nu10081049.","DOI":"10.3390\/nu10081049"},{"key":"1539_CR35","doi-asserted-by":"publisher","unstructured":"C. Kite et al., (2019). \"Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis,\" (in eng), Syst Rev, 8(1) 51, https:\/\/doi.org\/10.1186\/s13643-019-0962-3.","DOI":"10.1186\/s13643-019-0962-3"},{"key":"1539_CR36","doi-asserted-by":"publisher","unstructured":"G. E. Colombo et al., (2023). \"Comparison of selected exercise training modalities in the management of PCOS: A systematic review and meta-analysis to inform evidence-based guidelines,\" JSAMS Plus, vol. 2, p. 100024, https:\/\/doi.org\/10.1016\/j.jsampl.2023.100024.","DOI":"10.1016\/j.jsampl.2023.100024"},{"key":"1539_CR37","doi-asserted-by":"publisher","unstructured":"M. Hafizi Moori, S. Nosratabadi, N. Yazdi, R. Kasraei, Z. Abbasi Senjedary, and R. Hatami, (2023). The Effect of Exercise on Inflammatory Markers in PCOS Women: A Systematic Review and Meta-Analysis of Randomized Trials, (in eng), Int J Clin Pract. 2023: 3924018, https:\/\/doi.org\/10.1155\/2023\/3924018.","DOI":"10.1155\/2023\/3924018"},{"issue":"1","key":"1539_CR38","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1111\/cen.14913","volume":"99","author":"M Forslund","year":"2023","unstructured":"Forslund M et al (2023) Combined oral contraceptive pill compared with no medical treatment in the management of polycystic ovary syndrome: A systematic review. Clin Endocrinol 99(1):79\u201391. https:\/\/doi.org\/10.1111\/cen.14913","journal-title":"Clin Endocrinol"},{"key":"1539_CR39","doi-asserted-by":"publisher","unstructured":"J. Melin et al., (2023). \"Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis,\" The Journal of Clinical Endocrinology & Metabolism. https:\/\/doi.org\/10.1210\/clinem\/dgad465.","DOI":"10.1210\/clinem\/dgad465"},{"key":"1539_CR40","doi-asserted-by":"publisher","unstructured":"D. Glintborg and M. Andersen, (2020). \"Medical treatment and comorbidity in polycystic ovary syndrome: An updated review,Current Opinion in Endocrine and Metabolic Research, vol. 12: 33\u201340. https:\/\/doi.org\/10.1016\/j.coemr.2020.02.014.","DOI":"10.1016\/j.coemr.2020.02.014"},{"key":"1539_CR41","doi-asserted-by":"publisher","unstructured":"M. Ulhaq, E. Pamungkasari, and B. Murti, (2023). Meta Analysis: Effect of Oral Contraceptives on Obesity in Fertile Age Women in Asia, Journal of Maternal and Child Health. 5: 673\u2013682, https:\/\/doi.org\/10.26911\/thejmch.2020.05.06.07.","DOI":"10.26911\/thejmch.2020.05.06.07"},{"key":"1539_CR42","doi-asserted-by":"publisher","unstructured":"M. Le Guen, C. Schantz, A. R\u00e9gnier-Loilier, and E. de La Rochebrochard, (2021). Reasons for rejecting hormonal contraception in Western countries: A systematic review. Social Science & Medicine, 284, 114247. https:\/\/doi.org\/10.1016\/j.socscimed.2021.114247.","DOI":"10.1016\/j.socscimed.2021.114247"},{"issue":"1","key":"1539_CR43","doi-asserted-by":"publisher","first-page":"2022","DOI":"10.1001\/jamanetworkopen.2021.43730","volume":"5","author":"S Brabaharan","year":"2022","unstructured":"Brabaharan S et al (2022) \u201cAssociation of Hormonal Contraceptive Use With Adverse Health Outcomes: An Umbrella Review of Meta-analyses of Randomized Clinical Trials and Cohort Studies,\u201d (in English). JAMA Netw Open 5(1):2022. https:\/\/doi.org\/10.1001\/jamanetworkopen.2021.43730","journal-title":"JAMA Netw Open"},{"issue":"6","key":"1539_CR44","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1016\/j.ajog.2021.06.090","volume":"225","author":"AE de Wit","year":"2021","unstructured":"de Wit AE et al (2021) Efficacy of combined oral contraceptives for depressive symptoms and overall symptomatology in premenstrual syndrome: pairwise and network meta-analysis of randomized trials. Am J Obstet Gynecol 225(6):624\u2013633. https:\/\/doi.org\/10.1016\/j.ajog.2021.06.090","journal-title":"Am J Obstet Gynecol"},{"key":"1539_CR45","doi-asserted-by":"publisher","unstructured":"A. E. de Wit et al., (2021). \"Hormonal contraceptive use and depressive symptoms: systematic review and network meta-analysis of randomised trials,\" (in eng), BJPsych Open, vol. 7(4): e110, https:\/\/doi.org\/10.1192\/bjo.2021.64.","DOI":"10.1192\/bjo.2021.64"},{"key":"1539_CR46","unstructured":"R. Fenasse and B. McEwen, \"Impact of the oral contraceptive pill on health and nutritional status,\" Journal of the Australian Traditional Medicine Society, Article vol. 25, no. 4, pp. 197\u2013203, Summer2019 2019. [Online]. Available: https:\/\/search.ebscohost.com\/login.aspx?direct=true&AuthType=shib&db=a9h&AN=142817309&site=ehost-live&custid=s1165276."},{"key":"1539_CR47","doi-asserted-by":"publisher","unstructured":"F. R. P\u00e9rez-L\u00f3pez, G. R. P\u00e9rez-Roncero, M. T. L\u00f3pez-Baena, J. Santab\u00e1rbara, and P. Chedraui, (2020). \"Hormonal contraceptives and the risk of suicide: a systematic review and meta-analysis,\" European Journal of Obstetrics & Gynecology and Reproductive Biology. 251: 28\u201335, https:\/\/doi.org\/10.1016\/j.ejogrb.2020.04.053.","DOI":"10.1016\/j.ejogrb.2020.04.053"},{"key":"1539_CR48","doi-asserted-by":"publisher","unstructured":"T. Robakis, K. E. Williams, L. Nutkiewicz, and N. L. Rasgon, (2019). \"Hormonal Contraceptives and Mood: Review of the Literature and Implications for Future Research,\" Current Psychiatry Reports. 21(7), 57, https:\/\/doi.org\/10.1007\/s11920-019-1034-z.","DOI":"10.1007\/s11920-019-1034-z"},{"issue":"1","key":"1539_CR49","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1093\/ejendo\/lvad082","volume":"189","author":"M Forslund","year":"2023","unstructured":"Forslund M et al (2023) Different kinds of oral contraceptive pills in polycystic ovary syndrome: a systematic review and meta-analysis. Eur J Endocrinol 189(1):S1\u2013S16. https:\/\/doi.org\/10.1093\/ejendo\/lvad082","journal-title":"Eur J Endocrinol"},{"key":"1539_CR50","doi-asserted-by":"publisher","unstructured":"N. Moslehi, S. Zeraattalab-Motlagh, F. Rahimi Sakak, S. Shab-Bidar, F. R. Tehrani, P. Mirmiran, (2022). Effects of nutrition on metabolic and endocrine outcomes in women with polycystic ovary syndrome an umbrella review of meta-analyses of randomized controlled trials. Nutr Rev 81(5): 555\u2013577. https:\/\/doi.org\/10.1093\/nutrit\/nuac075.","DOI":"10.1093\/nutrit\/nuac075"},{"issue":"5","key":"1539_CR51","doi-asserted-by":"publisher","first-page":"2383","DOI":"10.26355\/eurrev_202103_25278","volume":"25","author":"T Cantelmi","year":"2021","unstructured":"Cantelmi T, Lambiase E, Unfer VR, Gambioli R, Unfer V (2021) \u201cInositol treatment for psychological symptoms in Polycystic Ovary Syndrome women,\u201d (in eng). Eur Rev Med Pharmacol Sci 25(5):2383\u20132389. https:\/\/doi.org\/10.26355\/eurrev_202103_25278","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"1539_CR52","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad762","author":"V Fitz","year":"2024","unstructured":"Fitz V et al (2024) Inositol for Polycystic Ovary Syndrome: a systematic review and meta-analysis to inform the 2023 update of the International Evidence-Based PCOS Guidelines. J Clin Endocrinol Metabol. https:\/\/doi.org\/10.1210\/clinem\/dgad762","journal-title":"J Clin Endocrinol Metabol"},{"issue":"5","key":"1539_CR53","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.25340","volume":"14","author":"S Rajashekar","year":"2022","unstructured":"Rajashekar S et al (2022) \u201cSpironolactone Versus Oral Contraceptive Pills in the Treatment of Adolescent Polycystic Ovarian Syndrome: A Systematic Review,\u201d (in eng). Cureus 14(5):e25340. https:\/\/doi.org\/10.7759\/cureus.25340","journal-title":"Cureus"},{"issue":"Suppl 2","key":"1539_CR54","doi-asserted-by":"publisher","first-page":"S1659","DOI":"10.4103\/jpbs.jpbs_391_21","volume":"13","author":"N Rani","year":"2021","unstructured":"Rani N et al (2021) \u201cEfficacy of Spironolactone in Adult Acne in Polycystic Ovary Syndrome Patients an Original Research,\u201d (in eng). J Pharm Bioallied Sci 13(Suppl 2):S1659-s1663. https:\/\/doi.org\/10.4103\/jpbs.jpbs_391_21","journal-title":"J Pharm Bioallied Sci"},{"key":"1539_CR55","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.102162","volume":"63","author":"S Alesi","year":"2023","unstructured":"Alesi S et al (2023) \u201cEfficacy and safety of anti-androgens in the management of polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials,\u201d (in eng). EClinicalMedicine 63:102162. https:\/\/doi.org\/10.1016\/j.eclinm.2023.102162","journal-title":"EClinicalMedicine"},{"key":"1539_CR56","doi-asserted-by":"publisher","unstructured":"X. Duan, M. Zhou, G. Zhou, Q. Zhu, and W. Li, (2021). Effect of metformin on adiponectin in PCOS: A meta-analysis and a systematic review, Europ J Obstetr Gynecol Reproduc Biol. 267: 61\u201367. https:\/\/doi.org\/10.1016\/j.ejogrb.2021.10.022.","DOI":"10.1016\/j.ejogrb.2021.10.022"},{"key":"1539_CR57","doi-asserted-by":"publisher","unstructured":"E. Garzia, V. Galiano, G. Marfia, S. Navone, E. Grossi, and A. M. Marconi, (2022). Hyperandrogenism and menstrual imbalance are the best predictors of metformin response in PCOS patients (in eng). Reprod Biol Endocrinol. 20(1): 6. https:\/\/doi.org\/10.1186\/s12958-021-00876-0.","DOI":"10.1186\/s12958-021-00876-0"},{"issue":"4","key":"1539_CR58","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1111\/cen.14013","volume":"91","author":"H Teede","year":"2019","unstructured":"Teede H et al (2019) Effect of the combined oral contraceptive pill and\/or metformin in the management of polycystic ovary syndrome: A systematic review with meta-analyses. Clin Endocrinol 91(4):479\u2013489. https:\/\/doi.org\/10.1111\/cen.14013","journal-title":"Clin Endocrinol"},{"issue":"1","key":"1539_CR59","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1530\/ec-19-0449","volume":"9","author":"M Jensterle","year":"2020","unstructured":"Jensterle M, Kravos NA, Ferjan S, Goricar K, Dolzan V, Janez A (2020) \u201cLong-term efficacy of metformin in overweight-obese PCOS: longitudinal follow-up of retrospective cohort,\u201d (in eng). Endocr Connect 9(1):44\u201354. https:\/\/doi.org\/10.1530\/ec-19-0449","journal-title":"Endocr Connect"},{"key":"1539_CR60","unstructured":"D. J. Cahill and K. O'Brien, \"Polycystic ovary syndrome (PCOS): metformin,\" (in eng), BMJ Clin Evid, vol. 2015, Mar 27 2015."},{"issue":"1","key":"1539_CR61","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1080\/17446651.2021.1865152","volume":"16","author":"G Papadakis","year":"2021","unstructured":"Papadakis G et al (2021) Tailoring treatment for PCOS phenotypes. Exp Rev Endocrinol Metabol. 16(1):9\u201318. https:\/\/doi.org\/10.1080\/17446651.2021.1865152","journal-title":"Exp Rev Endocrinol Metabol."},{"issue":"1","key":"1539_CR62","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s13098-021-00660-5","volume":"13","author":"NA Kravos","year":"2021","unstructured":"Kravos NA, Jane\u017e A, Gori\u010dar K, Dol\u017ean V, Jensterle M (2021) Effects of metformin withdrawal after long and short term treatment in PCOS: observational longitudinal study (in eng). Diabetol Metab Syndr 13(1):43. https:\/\/doi.org\/10.1186\/s13098-021-00660-5","journal-title":"Diabetol Metab Syndr"},{"issue":"5","key":"1539_CR63","first-page":"34","volume":"12","author":"S Sharma","year":"2019","unstructured":"Sharma S, Mathur DK, Paliwal V, Bhargava P (2019) \u201cEfficacy of Metformin in the Treatment of Acne in Women with Polycystic Ovarian Syndrome: A Newer Approach to Acne Therapy,\u201d (in eng). J Clin Aesthet Dermatol 12(5):34\u201338","journal-title":"J Clin Aesthet Dermatol"},{"issue":"5","key":"1539_CR64","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.1016\/j.jaad.2020.12.071","volume":"84","author":"V Garg","year":"2021","unstructured":"Garg V, Choi JK, James WD, Barbieri JS (2021) Long-term use of spironolactone for acne in women A case series of 403 patients. J Amr Acad Dermat 84(5):1348\u20131355. https:\/\/doi.org\/10.1016\/j.jaad.2020.12.071","journal-title":"J Amr Acad Dermat"},{"issue":"1","key":"1539_CR65","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1111\/pde.14391","volume":"38","author":"EE Roberts","year":"2021","unstructured":"Roberts EE, Nowsheen S, Davis DMR, Hand JL, Tollefson MM, Wetter DA (2021) Use of spironolactone to treat acne in adolescent females. Pediatr Dermatol 38(1):72\u201376. https:\/\/doi.org\/10.1111\/pde.14391","journal-title":"Pediatr Dermatol"},{"key":"1539_CR66","doi-asserted-by":"publisher","first-page":"603","DOI":"10.2147\/ccid.S398950","volume":"16","author":"C Wang","year":"2023","unstructured":"Wang C, Du Y, Bi L, Lin X, Zhao M, Fan W (2023) \u201cThe Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review,\u201d (in eng). Clin Cosmet Investig Dermatol 16:603\u2013612. https:\/\/doi.org\/10.2147\/ccid.S398950","journal-title":"Clin Cosmet Investig Dermatol"},{"issue":"1","key":"1539_CR67","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.rbmo.2015.09.015","volume":"32","author":"H Abu Hashim","year":"2016","unstructured":"Abu Hashim H (2016) \"Twenty years of ovulation induction with metformin for PCOS; what is the best available evidence? Reproduct BioMed Online. 32(1):44\u201353. https:\/\/doi.org\/10.1016\/j.rbmo.2015.09.015","journal-title":"Reproduct BioMed Online."},{"issue":"2","key":"1539_CR68","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1055\/s-0043-1761215","volume":"15","author":"NTY Alibrahim","year":"2023","unstructured":"Alibrahim NTY, Chasib MG, Hamadi SS, Mansour AA (2023) Predictors of Metformin Side Effects in Patients with Newly Diagnosed Type 2 Diabetes Mellitus. Ibnosina J Med Biomed Sci 15(2):67\u201373. https:\/\/doi.org\/10.1055\/s-0043-1761215","journal-title":"Ibnosina J Med Biomed Sci"},{"issue":"11","key":"1539_CR69","doi-asserted-by":"publisher","first-page":"6179","DOI":"10.52711\/0974-360X.2021.01070","volume":"14","author":"M Avijit","year":"2021","unstructured":"Avijit M, Ashini S (2021) A Review on Metformin: Clinical Significance and Side Effects, (in English). Res J Pharm Technol 14(11):6179\u20136186. https:\/\/doi.org\/10.52711\/0974-360X.2021.01070","journal-title":"Res J Pharm Technol"},{"issue":"2","key":"1539_CR70","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1159\/000492035","volume":"5","author":"AM Hosking","year":"2019","unstructured":"Hosking AM, Juhasz M, Atanaskova Mesinkovska N (2019) Complementary and Alternative Treatments for Alopecia A Comprehensive Review,\" (in eng). Skin Append Disord 5(2):72\u201389. https:\/\/doi.org\/10.1159\/000492035","journal-title":"Skin Append Disord"},{"issue":"6","key":"1539_CR71","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1159\/000509905","volume":"6","author":"E Evron","year":"2020","unstructured":"Evron E, Juhasz M, Babadjouni A, Mesinkovska NA (2020) Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia. Skin Appendage Disorders 6(6):329\u2013337. https:\/\/doi.org\/10.1159\/000509905","journal-title":"Skin Appendage Disorders"},{"issue":"2","key":"1539_CR72","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1002\/ptr.2900","volume":"24","author":"P Grant","year":"2010","unstructured":"Grant P (2010) Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. a randomized controlled trial. Phytother Res 24(2):186\u2013188. https:\/\/doi.org\/10.1002\/ptr.2900","journal-title":"Phytother Res"},{"issue":"5","key":"1539_CR73","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1002\/ptr.2074","volume":"21","author":"M Akdo\u011fan","year":"2007","unstructured":"Akdo\u011fan M, Tamer MN, C\u00fcre E, C\u00fcre MC, K\u00f6ro\u011flu BK, Deliba\u015f N (2007) Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism. Phytother Res 21(5):444\u2013447. https:\/\/doi.org\/10.1002\/ptr.2074","journal-title":"Phytother Res"},{"key":"1539_CR74","doi-asserted-by":"publisher","unstructured":"R. H. K. Emanuel, J. Roberts, P. D. Docherty, H. Lunt, R. E. Campbell, and K. M\u00f6ller, (2022). A review of the hormones involved in the endocrine dysfunctions of polycystic ovary syndrome and their interactions. (in English), Frontiers in Endocrinology, Review. https:\/\/doi.org\/10.3389\/fendo.2022.1017468.","DOI":"10.3389\/fendo.2022.1017468"},{"issue":"16","key":"1539_CR75","doi-asserted-by":"publisher","first-page":"1352","DOI":"10.1001\/jama.2023.4855","volume":"329","author":"RC Sheldrick","year":"2023","unstructured":"Sheldrick RC (2023) Randomized Trials vs Real-world Evidence: How Can Both Inform Decision-making? JAMA 329(16):1352\u20131353. https:\/\/doi.org\/10.1001\/jama.2023.4855","journal-title":"JAMA"},{"key":"1539_CR76","doi-asserted-by":"publisher","unstructured":"H. J. Teede et al., (2024). International PCOS guideline clinical research priorities roadmap: a co-designed approach aligned with end-user priorities in a neglected womens health condition. eClinicalMedicine, https:\/\/doi.org\/10.1016\/j.eclinm.2024.102927.","DOI":"10.1016\/j.eclinm.2024.102927"},{"issue":"4","key":"1539_CR77","doi-asserted-by":"publisher","first-page":"457","DOI":"10.4300\/jgme-d-21-00599.1","volume":"13","author":"GM Sullivan","year":"2021","unstructured":"Sullivan GM, Feinn RS (2021) \u201cFacts and Fictions About Handling Multiple Comparisons,\u201d (in eng). J Grad Med Educ 13(4):457\u2013460. https:\/\/doi.org\/10.4300\/jgme-d-21-00599.1","journal-title":"J Grad Med Educ"}],"container-title":["Physical and Engineering Sciences in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13246-025-01539-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13246-025-01539-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13246-025-01539-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T11:55:54Z","timestamp":1751284554000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13246-025-01539-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":77,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["1539"],"URL":"https:\/\/doi.org\/10.1007\/s13246-025-01539-9","relation":{},"ISSN":["2662-4729","2662-4737"],"issn-type":[{"value":"2662-4729","type":"print"},{"value":"2662-4737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,14]]},"assertion":[{"value":"18 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 May 2025","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The orginal online version of this article was revised: In this article the sentence \u2018The network diagram displaying commonly paired treatments shows that the most common treatment combination was metformin and spironolactone (Error! Reference source not found. 3).' was corrected to \u2018The network diagram displaying commonly paired treatments shows that the most common treatment combination was metformin and spironolactone (Fig. 3).'","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have not disclosed any competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}}]}}