Taking both metformin and oral contraceptives significantly improved health-related quality of life in women with polycystic ovary syndrome (PCOS), based on new data presented at the American Society for Reproductive Medicine (ASRM) 2025 annual meeting.

PCOS is also related to increased depression and anxiety and impaired sexual function, said Sanjana Satish, MD, resident at the University of Pennsylvania, Philadelphia, and colleagues. The combination of metformin and oral contraceptive pills is a staple PCOS therapy, but studies of their effect on mental health and sexual function are limited, the researchers said.

The researchers reviewed data from 240 women with hyperandrogenic PCOS and a BMI ≥ 25 who were randomly assigned to 6 months of treatment with either combined oral contraceptive pills (COCPs; combined estrogen-progesterone, 20 μg ethinyl estradiol/0.15 mg desogestrel), metformin XR (2000 mg/d), or both medications.

Participants’ quality of life, sexual function, anxiety, and depression were determined using the modified PCOS questionnaire (PCOSQ), the Center for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory Forms Y-1 and Y-2, the Female Sexual Function Index (FSFI), and the Female Sexual Distress Scale (FSDS).

The modified PCOSQ scores improved significantly from baseline across all domains in the combined group, except for the menstrual health domain for the COCP group and the body hair and weight domains for the metformin group (P < .01 for all improvements).

Depression scores remained unchanged in the COCP and combined groups but significantly improved in the metformin-only group (P < .01). State anxiety improved in the metformin-only and combined groups, and trait anxiety improved in all groups (P < .01 for both).

Overall, FSFI scores were lower in the COCP group only (P = .02), but FSDS scores decreased significantly in the COCP and metformin groups (P = .03 and P < .01, respectively). “There were no significant differences in prevalence of sexual dysfunction before and after intervention in all groups,” the researchers noted.

The study findings were limited by the relatively small sample size, but the findings are reassuring, as they highlight the improved health-related quality of life associated with both COCPs and metformin, without negative effects on mental health and sexual function, the researchers said.

Easing Patient Burdens

“PCOS is the most common hormonal disorder in women and is the main reason for ovulation disorders, female infertility, and, possibly, infertility in couples,” said Mark P. Trolice, MD, who was not involved in the study.

Current guidelines emphasize the need for evidence-based management strategies that address quality-of-life domains, not just metabolic or reproductive endpoints, said Trolice, professor at the University of Central Florida College of Medicine and founder or medical director of the IVF Center of Central Florida, Orlando, Florida.

“The new findings that both COCPs and metformin improved health-related quality of life, with combination therapy showing the greatest improvements, and that mood (depression and anxiety) improved in most groups, are consistent with prior evidence,” said Trolice. However, the mixed results for sexual function were somewhat unexpected, he said.

That sexual function outcomes may not be uniformly improved should be discussed with patients, said Trolice. “Treatment selection should be individualized, considering the patient’s symptom profile, metabolic risk, and preferences, as recommended by major guidelines, and clinicians should routinely screen for and address psychological and sexual health concerns in women with PCOS,” he added.

Looking ahead, studies are needed to clarify the impact of these therapies on sexual function and to evaluate subtypes of PCOS for outcomes, Trolice told Medscape Medical News. “Research also should focus on long-term mental health outcomes, patient-centered endpoints, and stratification by BMI and metabolic risk,” he said.

The study reported receiving no outside funding. The researchers and Trolice disclosed having no financial conflicts of interest.