GLP-1 and SGLT2 drugs both improve PCOS, with SGLT2 better for hormones and combination therapy showing most promise | Research

The takeaway

NMA of 27 RCTs (1,642 PCOS patients) shows GLP-1RAs improve menstrual frequency, weight, and androgens while SGLT2i better reduce testosterone and insulin resistance—with combination therapy superior to monotherapy for weight and glucose.

Combination > monotherapy
Combining GLP-1 and SGLT2 drugs outperformed either alone for weight, fat mass, and glucose in PCOS—supporting dual therapy for this complex condition

What the researchers found

GLP-1RAs: improved menstrual frequency, weight, FAI, free testosterone, androstenedione, SHBG, triglycerides, insulin resistance, glucose. SGLT2is: improved FAI, total testosterone, WHR, AGF, HOMA-IR (outperformed GLP-1 for FAI, testosterone, LDL, HOMA-IR). Combination > monotherapy for weight, fat, triglycerides, glucose. 27 RCTs, 1,642 patients.

Why it matters

PCOS affects 5-15% of reproductive-age women with limited treatment options. This is the most comprehensive comparison of GLP-1 and SGLT2 drugs for PCOS, revealing distinct strengths that support personalized treatment selection.

How the study worked

Systematic review and network meta-analysis of 27 RCTs (1,642 participants). Random-effects NMA. Plus systematic review of preclinical studies.

What this study cannot tell us

Very low evidence quality (GRADE). NMA indirect comparisons. Heterogeneous PCOS definitions and outcomes. Short trial durations. Limited fertility outcome data.

How to read the evidence

NMA of 27 RCTs but evidence quality rated very low. Hypothesis-generating for combination therapy.

When this study was published

Published in 2025.

The bigger picture

Both GLP-1 and SGLT2 drugs target the metabolic dysfunction underlying PCOS—but through different mechanisms. Combination therapy could address more PCOS features simultaneously than either alone.

Questions still open

Should combination GLP-1+SGLT2 become standard for metabolic PCOS?
Which PCOS phenotype benefits most from each drug class?
Do these metabolic improvements translate to improved fertility?

Common questions

Can GLP-1 drugs help with PCOS?

This large analysis shows GLP-1 drugs improve multiple PCOS features: menstrual regularity, weight, and androgen levels. SGLT2 inhibitors are better at reducing testosterone and insulin resistance. Combining both types of drugs appears to work best for weight and blood sugar control.

Which drug is better for PCOS: GLP-1 or SGLT2?

They have different strengths. GLP-1 drugs are better for weight loss and improving menstrual frequency. SGLT2 inhibitors are better for reducing male hormones (testosterone) and insulin resistance. The combination of both was superior to either alone for several metabolic measures.

Read the original research

Expanding therapeutic horizons: glucagon-like peptide-1 receptor agonists and sodium glucose transporter-2 inhibitors in poly cystic ovarian syndrome: a comprehensive review including systematic review and network meta-analysis of randomized clinical trials.

Diabetology & metabolic syndrome, 17(1), 168

View on PubMed ↗Publisher’s paper ↗

Citation

Sridharan, Kannan; Sivaramakrishnan, Gowri. (2025). Expanding therapeutic horizons: glucagon-like peptide-1 receptor agonists and sodium glucose transporter-2 inhibitors in poly cystic ovarian syndrome: a comprehensive review including systematic review and network meta-analysis of randomized clinical trials.. Diabetology & metabolic syndrome, 17(1), 168. https://doi.org/10.1186/s13098-025-01730-8