{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T15:16:21Z","timestamp":1787930181493,"version":"build-2784847793"},"reference-count":71,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T00:00:00Z","timestamp":1754697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Polycystic Ovary Syndrome (PCOS), as a multifactorial chronic disease, can cause heterogeneous metabolic, physical, and psychological disorders as well as infertility in both obese and non-obese patients. Therefore, this review aimed to present differences in pathophysiology, clinical presentation, and therapy in obese and non-obese patients with PCOS. Methods: A non-systematic review was conducted by searching papers published in English from 2010 to 2024 in MEDLINE. Results: Obesity in PCOS significantly contributes to IR and worsens metabolic dysfunction. Lifestyle modifications, including a balanced diet and regular exercise, are the first line of treatment. Pharmacological therapies, such as metformin, GLP-1 receptor agonists, myoinositol, and resveratrol, are used to improve insulin sensitivity, regulate the hormonal milieu, and reduce hyperandrogenism. Metformin is widely used to improve glucose metabolism and reduce androgen levels, while myoinositol is effective in promoting ovarian function. GLP-1 receptor agonists and resveratrol improve metabolic and reproductive outcomes. For patients with severe obesity, bariatric surgery offers substantial improvements in body composition, metabolic function, and fertility. Combination therapies, such as metformin and GLP-1 receptor agonists, provide comprehensive treatment for both reproductive and metabolic aspects of PCOS. Conclusions: The first-line treatment for PCOS is a lifestyle-modifying strategy. PCOS patients with insulin resistance and obesity would mostly benefit from combination therapy with metformin and GLP-1 receptor agonists.<\/jats:p>","DOI":"10.3390\/jcm14165642","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T09:59:13Z","timestamp":1754906353000},"page":"5642","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Obesity as a Part of Polycysric Ovary Syndrome (PCOS)\u2014A Review of Pathophysiology and Comprehensive Therapeutic Strategies"],"prefix":"10.3390","volume":"14","author":[{"given":"Jovan","family":"Bila","sequence":"first","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9683-9561","authenticated-orcid":false,"given":"Jelena","family":"Dotlic","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mladen","family":"Andjic","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9176-9736","authenticated-orcid":false,"given":"Katarina","family":"Ivanovic","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5686-0307","authenticated-orcid":false,"given":"Jelena","family":"Micic","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5706-0707","authenticated-orcid":false,"given":"Lidija","family":"Tulic","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miljan","family":"Pupovac","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0359-9568","authenticated-orcid":false,"given":"Jelena","family":"Stojnic","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Vukovic","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Ivanovic","sequence":"additional","affiliation":[{"name":"The Obstetrics and Gynecology Clinic Narodni Front, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Teede, H., Tay, C.T., Laven, J., Dokras, A., Moran, L., Piltonen, T., Costello, M., Boivin, J., Redman, L., and Boyle, J. (2023). International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023, ESHRE.","DOI":"10.1210\/clinem\/dgad463"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Meng, Y., Zhao, T., Zhang, R., Zhu, X., Ma, C., and Shi, Q. (2025). Global burden of polycystic ovary syndrome among women of childbearing age, 1990\u20132021: A systematic analysis using the global burden of disease study 2021. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1514250"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.fertnstert.2018.05.004","article-title":"Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome","volume":"110","author":"Teede","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.metabol.2018.11.002","article-title":"Characteristics of obesity in polycystic ovary syndrome: Etiology, treatment, and genetics","volume":"92","author":"Glueck","year":"2019","journal-title":"Metabolism"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.fertnstert.2024.10.028","article-title":"Polycystic ovarian syndrome, obesity, and insulin resistance: Intertwined comorbidities that impact ART success","volume":"123","author":"Smigoc","year":"2024","journal-title":"Fertil. Steril."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Treister-Goltzman, Y., Nemet, D., and Menashe, I. (2024). Associations of adolescent obesity with hypertension, diabetes mellitus and polycystic ovaries in Arabs and Jews in Israel\u2014A nationwide study. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1443756"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s13048-022-01091-0","article-title":"Insulin resistance in polycystic ovary syndrome across various tissues: An updated review of pathogenesis, evaluation, and treatment","volume":"16","author":"Zhao","year":"2023","journal-title":"J. Ovarian Res."},{"key":"ref_8","unstructured":"NCD Risk Factor Collaboration (NCD-RisC) (2024). Worldwide trends in underweight and obesity from 1990 to 2022: A pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet, 403, 1027\u20131050."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2497854","DOI":"10.1080\/09513590.2025.2497854","article-title":"Reproductive hormone characteristics of obese Chinese patients with polycystic ovarian syndrome: A meta-analysis","volume":"41","author":"Chen","year":"2025","journal-title":"Gynecol. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Venkatesh, S.S., Ferreira, T., Benonisdottir, S., Rahmioglu, N., Becker, C.M., Granne, I., Zondervan, K.T., Holmes, M.V., Lindgren, C.M., and Wittemans, L.B.L. (2022). Obesity and risk of female reproductive conditions: A Mendelian randomisation study. PLoS Med., 19.","DOI":"10.1371\/journal.pmed.1004095"},{"key":"ref_11","first-page":"46","article-title":"Comparative observation of metabolic changes in obese and non-obese patients with polycystic ovary syndrome","volume":"29","author":"Feng","year":"2017","journal-title":"J. Henan Med. Coll."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1093\/humrep\/dead053","article-title":"Childhood, adolescent, and adulthood adiposity are associated with risk of PCOS: A Mendelian randomization study with meta-analysis","volume":"38","author":"Dobbie","year":"2023","journal-title":"Hum. Reprod."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Burns, K., Mullin, B.H., Moolhuijsen, L.M.E., Laisk, T., Tyrmi, J.S., Cui, J., Actkins, K.V., Louwers, Y.V., Davis, L.K., and Dudbridge, F. (2024). Body mass index stratified meta-analysis of genome-wide association studies of polycystic ovary syndrome in women of European ancestry. BMC Genom., 25.","DOI":"10.1186\/s12864-024-09990-w"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Liu, Q., Zhu, Z., Kraft, P., Deng, Q., Stener-Victorin, E., and Jiang, X. (2022). Genomic correlation, shared loci, and causal relationship between obesity and polycystic ovary syndrome: A large-scale genome-wide cross-trait analysis. BMC Med., 20.","DOI":"10.1186\/s12916-022-02238-y"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Carmina, E., and Lobo, R.A. (2022). Comparing Lean and Obese PCOS in Different PCOS Phenotypes: Evidence That the Body Weight Is More Important than the Rotterdam Phenotype in Influencing the Metabolic Status. Diagnostics, 12.","DOI":"10.3390\/diagnostics12102313"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Christ, J.P., and Cedars, M.I. (2023). Current Guidelines for Diagnosing PCOS. Diagnostics, 13.","DOI":"10.3390\/diagnostics13061113"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.fertnstert.2016.05.003","article-title":"Criteria, prevalence, and phenotypes of polycystic ovary syndrome","volume":"106","author":"Lizneva","year":"2016","journal-title":"Fertil. Steril."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.tem.2023.08.005","article-title":"Questioning PCOS phenotypes for reclassification and tailored therapy","volume":"34","author":"Myers","year":"2023","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_19","first-page":"569862","article-title":"Phenotype and metabolic disorders in polycystic ovary syndrome","volume":"2012","author":"Glinicki","year":"2012","journal-title":"ISRN Endocrinol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1159\/000514218","article-title":"The European Association for the Study of Obesity (EASO) Endorses the Milan Charter on Urban Obesity","volume":"14","author":"Carruba","year":"2021","journal-title":"Obes. Facts"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"132","DOI":"10.4103\/jhrs.jhrs_60_23","article-title":"Variation in Clinical Presentation, Metabolic Profile, Hormonal Parameters and Inflammatory Markers in Polycystic Ovary Syndrome Women with and without Polycystic Ovary Morphology Appearance","volume":"16","author":"Jena","year":"2023","journal-title":"J. Hum. Reprod. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"249","DOI":"10.2147\/TACG.S200341","article-title":"Genetic Basis of Polycystic Ovary Syndrome (PCOS): Current Perspectives","volume":"12","author":"Khan","year":"2019","journal-title":"Appl. Clin. Genet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1007\/s00125-022-05746-x","article-title":"A genome-wide cross-trait analysis identifies shared loci and causal relationships of type 2 diabetes and glycaemic traits with polycystic ovary syndrome","volume":"65","author":"Liu","year":"2022","journal-title":"Diabetologia"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Zhao, S., Tian, Y., Gao, X., Zhang, X., Liu, H., You, L., Cao, Y., Su, S., Chan, W.-Y., and Sun, Y. (2015). Family-based analysis of eight susceptibility loci in polycystic ovary syndrome. Sci. Rep., 5.","DOI":"10.1038\/srep12619"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Laven, J.S.E. (2019). Follicle Stimulating Hormone Receptor (FSHR) Polymorphisms and Polycystic Ovary Syndrome (PCOS). Front. Endocrinol., 10.","DOI":"10.3389\/fendo.2019.00023"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Singh, S., Pal, N., Shubham, S., Sarma, D.K., Verma, V., Marotta, F., and Kumar, M. (2023). Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. J. Clin. Med., 12.","DOI":"10.3390\/jcm12041454"},{"key":"ref_27","first-page":"260","article-title":"Insulin resistance and adverse metabolic profile in overweight\/obese and normal weight of young women with polycystic ovary syndrome","volume":"9","author":"Gholinezhad","year":"2018","journal-title":"Casp. J. Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/humrep\/des463","article-title":"Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp","volume":"28","author":"Stepto","year":"2013","journal-title":"Hum. Reprod."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"163.e1","DOI":"10.1016\/j.ajog.2014.03.035","article-title":"Effect of body mass index on in vitro fertilization outcomes in women with polycystic ovary syndrome","volume":"211","author":"Bailey","year":"2014","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"168","DOI":"10.3892\/ol.2023.13754","article-title":"Risk of endometrial cancer in patients with polycystic ovarian syndrome: A meta-analysis","volume":"25","author":"Johnson","year":"2023","journal-title":"Oncol. Lett."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Hong, S.H., Sung, Y.A., Hong, Y.S., Song, D.K., Jung, H., Jeong, K., Chung, H., and Lee, H. (2023). Non-alcoholic fatty liver disease is associated with hyperandrogenism in women with polycystic ovary syndrome. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-39428-4"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s40200-018-0371-5","article-title":"Lean polycystic ovary syndrome (PCOS): An evidence-based practical approach","volume":"17","author":"Toosy","year":"2018","journal-title":"J. Diabetes Metab. Disord."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Armanini, D., Boscaro, M., Bordin, L., and Sabbadin, C. (2022). Controversies in the Pathogenesis, Diagnosis and Treatment of PCOS: Focus on Insulin Resistance, Inflammation, and Hyperandrogenism. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23084110"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1210\/er.2015-1104","article-title":"The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited","volume":"37","author":"Rosenfield","year":"2016","journal-title":"Endocr. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"100123","DOI":"10.1016\/j.metop.2021.100123","article-title":"PCOS and nutritional approaches: Differences between lean and obese phenotype","volume":"12","author":"Barrea","year":"2021","journal-title":"Metab. Open"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Tong, C., Wu, Y., Zhang, L., and Yu, Y. (2022). Insulin resistance, autophagy and apoptosis in patients with polycystic ovary syndrome: Association with PI3K signaling pathway. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.1091147"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Barber, T.M., Kyrou, I., Randeva, H.S., and Weickert, M.O. (2021). Mechanisms of Insulin Resistance at the Crossroad of Obesity with Associated Metabolic Abnormalities and Cognitive Dysfunction. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22020546"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.lfs.2019.04.046","article-title":"Multi-system reproductive metabolic disorder: Significance for the pathogenesis and therapy of polycystic ovary syndrome (PCOS)","volume":"228","author":"Li","year":"2019","journal-title":"Life Sci."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Szczuko, M., Kikut, J., Szczuko, U., Szyd\u0142owska, I., Nawrocka-Rutkowska, J., Zi\u0119tek, M., Verbanac, D., and Saso, L. (2021). Nutrition Strategy and Life Style in Polycystic Ovary Syndrome\u2014Narrative Review. Nutrients, 13.","DOI":"10.3390\/nu13072452"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3346","DOI":"10.1210\/clinem\/dgaa425","article-title":"Effect of Diet on Insulin Resistance in Polycystic Ovary Syndrome","volume":"105","author":"Shang","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.ejogrb.2020.03.010","article-title":"Diets with lower carbohydrate concentrations improve insulin sensitivity in women with polycystic ovary syndrome: A meta-analysis","volume":"248","author":"Porchia","year":"2020","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Patten, R.K., Boyle, R.A., Moholdt, T., Kiel, I., Hopkins, W.G., Harrison, C.L., and Stepto, N.K. (2020). Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Front. Physiol., 11.","DOI":"10.3389\/fphys.2020.00606"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1016\/j.soard.2019.03.032","article-title":"Effects of bariatric surgery on obese polycystic ovary syndrome: A systematic review and meta-analysis","volume":"15","author":"Li","year":"2019","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"5083","DOI":"10.1016\/j.asjsur.2024.04.003","article-title":"A meta-analysis of bariatric surgery in patients with obesity and polycystic ovary syndrome","volume":"47","author":"Chen","year":"2024","journal-title":"Asian J. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"5150684","DOI":"10.1155\/2020\/5150684","article-title":"The Effect of Metformin on Polycystic Ovary Syndrome in Overweight Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"2020","author":"Guan","year":"2020","journal-title":"Int. J. Endocrinol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Greff, D., Juh\u00e1sz, A.E., V\u00e1ncsa, S., V\u00e1radi, A., Sipos, Z., Szinte, J., Park, S., Hegyi, P., Nyir\u00e1dy, P., and \u00c1cs, N. (2023). Inositol is an effective and safe treatment in polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. Reprod. Biol. Endocrinol., 21.","DOI":"10.1186\/s12958-023-01055-z"},{"key":"ref_47","first-page":"134","article-title":"Efficacy of resveratrol in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized clinical trials","volume":"44","author":"Elhusein","year":"2023","journal-title":"Pan Afr. Med. J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.4240\/wjgs.v15.i11.2423","article-title":"Effect of laparoscopic sleeve gastrectomy on related variables of obesity complicated with polycystic ovary syndrome","volume":"15","author":"Wang","year":"2023","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1530\/EC-19-0449","article-title":"Long-term efficacy of metformin in overweight-obese PCOS: Longitudinal follow-up of retrospective cohort","volume":"9","author":"Jensterle","year":"2020","journal-title":"Endocr. Connect."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1038\/nm.3787","article-title":"Metformin activates a duodenal Ampk-dependent pathway to lower hepatic glucose production in rats","volume":"21","author":"Duca","year":"2015","journal-title":"Nat. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.mce.2012.06.012","article-title":"AMPK and the neuroendocrine regulation of appetite and energy expenditure","volume":"366","author":"Stark","year":"2013","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.rbmo.2019.04.017","article-title":"GLP-1 receptor agonists versus metformin in PCOS: A systematic review and meta-analysis","volume":"39","author":"Han","year":"2019","journal-title":"Reprod. Biomed. Online"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/MED.0000000000000095","article-title":"Effects of metformin on weight loss: Potential mechanisms","volume":"21","author":"Malin","year":"2014","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Kamenov, Z., and Gateva, A. (2020). Inositols in PCOS. Molecules, 25.","DOI":"10.3390\/molecules25235566"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1111\/cen.14931","article-title":"A randomized controlled trial comparing myoinositol with metformin versus metformin monotherapy in polycystic ovary syndrome","volume":"99","author":"Nazirudeen","year":"2023","journal-title":"Clin. Endocrinol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s40618-021-01691-5","article-title":"The effect of metformin and myoinositol on metabolic outcomes in women with polycystic ovary syndrome: Role of body mass and adiponectin in a randomized controlled trial","volume":"45","author":"Prtina","year":"2022","journal-title":"J. Endocrinol. Investig."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1007\/s12020-022-03198-2","article-title":"Treatment with combined resveratrol and myoinositol ameliorates endocrine, metabolic alterations and perceived stress response in women with PCOS: A double-blind randomized clinical trial","volume":"79","author":"Hassan","year":"2023","journal-title":"Endocrine"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2950","DOI":"10.1210\/clinem\/dgaa337","article-title":"Insulin Sensitizers for Improving the Endocrine and Metabolic Profile in Overweight Women With PCOS","volume":"105","author":"Xing","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1056\/NEJMoa2032183","article-title":"Once-Weekly Semaglutide in Adults with Overweight or Obesity","volume":"384","author":"Wilding","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"108834","DOI":"10.1016\/j.jdiacomp.2024.108834","article-title":"The Efficacy and Safety of GLP-1 Agonists in PCOS Women Living with Obesity in Promoting Weight Loss and Hormonal Regulation: A Meta-Analysis of Randomized Controlled Trials","volume":"38","author":"Rodrigues","year":"2024","journal-title":"J. Diabetes Its Complicat."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1210\/clinem\/dgad762","article-title":"Inositol for Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis to Inform the 2023 Update of the International Evidence-Based PCOS Guidelines","volume":"109","author":"Fitz","year":"2024","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1210\/clinem\/dgad463","article-title":"Recommendations from the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome","volume":"108","author":"Teede","year":"2023","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Baldassarre, M.P.A., Di Tomo, P., Centorame, G., Pandolfi, A., Di Pietro, N., Consoli, A., and Formoso, G. (2021). Myoinositol Reduces Inflammation and Oxidative Stress in Human Endothelial Cells Exposed In Vivo to Chronic Hyperglycemia. Nutrients, 13.","DOI":"10.3390\/nu13072210"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Bednarz, K., Kowalczyk, K., Cwynar, M., Czapla, D., Czarkowski, W., Kmita, D., Nowak, A., and Madej, P. (2022). The Role of GLP-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23084334"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1484321","DOI":"10.1155\/2020\/1484321","article-title":"GLP-1\/GLP-1R Signaling Regulates Ovarian PCOS-Associated Granulosa Cells Proliferation and Antiapoptosis by Modification of Forkhead Box Protein O1 Phosphorylation Sites","volume":"2020","author":"Sun","year":"2020","journal-title":"Int. J. Endocrinol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1007\/s00125-016-3992-6","article-title":"Once-daily delayed-release metformin lowers plasma glucose and enhances fasting and postprandial GLP-1 and PYY: Results from two randomised trials","volume":"59","author":"DeFronzo","year":"2016","journal-title":"Diabetologia"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Tilinca, M.C., Tiuca, R.A., Burlacu, A., and Varga, A. (2021). A 2021 Update on the Use of Liraglutide in the Modern Treatment of \u2018Diabesity\u2019: A Narrative Review. Medicina, 57.","DOI":"10.3390\/medicina57070669"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2882","DOI":"10.1097\/CM9.0000000000001712","article-title":"Short-term combined treatment with exenatide and metformin for overweight\/obese women with polycystic ovary syndrome","volume":"134","author":"Ma","year":"2021","journal-title":"Chin. Med. J."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Xing, C., Zhao, H., Zhang, J., and He, B. (2022). Effect of metformin versus metformin plus liraglutide on gonadal and metabolic profiles in overweight patients with polycystic ovary syndrome. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.945609"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Spremovi\u0107 Ra\u0111enovi\u0107, S., Pupovac, M., Andji\u0107, M., Bila, J., Sre\u0107kovi\u0107, S., Gudovi\u0107, A., Draga\u0161, B., and Radunovi\u0107, N. (2022). Prevalence, Risk Factors, and Pathophysiology of Nonalcoholic Fatty Liver Disease (NAFLD) in Women with Polycystic Ovary Syndrome (PCOS). Biomedicines, 10.","DOI":"10.3390\/biomedicines10010131"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"142","DOI":"10.31083\/j.ceog5106142","article-title":"Lean Polycystic Ovary Syndrome: A Narrative Review","volume":"51","author":"Elnashar","year":"2024","journal-title":"Clin. Exp. Obstet. Gynecol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5642\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:27:16Z","timestamp":1760034436000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5642"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,9]]},"references-count":71,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14165642"],"URL":"https:\/\/doi.org\/10.3390\/jcm14165642","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,9]]}}}