Polycystic ovarian syndrome (PCOS) is an endocrine disorder that affects women of reproductive age and is characterized by hyperandrogenism, unpredictable ovulation, and a polycystic ovary shape. It is accompanied by metabolic problems, such as obesity and insulin resistance (IR). Factors contributing to PCOS include genetics, epigenetic changes, environmental factors, oxidative stress, chronic inflammation, mitochondrial dysfunction, and metabolic abnormalities. Insulin resistance is the most prevalent classical phenotype, and metformin was the first insulin-sensitizing drug to be used to study its role. Metformin, derived from galegine, inhibits mitochondrial function, activates AMPK, enhances hepatic insulin sensitivity, and lowers the risk of type 2 diabetes in PCOS patients. It also affects tumor growth, with a 30% reduction in the overall tumor onsets in T2DM patients. Metformin treatment has been linked to low rates of multiple pregnancies, increased fetal concentrations of sex hormone-binding globulin, and decreased levels of inflammatory cytokines. It can reduce the risk of endometrial cancer, type 2 diabetes mellitus, cardiovascular disease, dyslipidemia, and hypertension in women with PCOS.
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