Effectiveness and safety of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors in women with polycystic ovary syndrome and obesity

DOI

https://dx.doi.org/10.18565/aig.2025.288

Shipilova G.A., Konakova I.V., Ter-Ovanesova O.A., Sheshukova N.A., Levakov S.A.
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia

Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by a complex of metabolic disorders (obesity, insulin resistance) and reproductive dysfunctions (hyperandrogenism, anovulation). Traditional metformin therapy often fails to produce desired results.
Objective: To conduct a systematic assessment of the efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter (SGLT2) inhibitors in women with PCOS and obesity and to evaluate the effect of these medications on body weight, metabolic parameters, reproductive function and hyperandrogenism.
Materials and methods: A systematic search was conducted in the PubMed, CyberLeninka, eLibrary databases.
Results: According to the findings of a network meta-analysis conducted by Tan et al. in 2023, which included 47 randomized controlled trials and 18 studies focused on reproductive outcomes, GLP-1RAs were found to be the most effective in reducing body mass index and total body weight significantly exceeding the effect of metformin and SGLT2 inhibitors. GLP-1RA therapy is associated with a considerable improvement in glycemic control, an increase in ovulation frequency, and a decrease in free testosterone levels. SGLT2 inhibitors showed moderate efficacy in weight loss and improved reproductive function, but it had advantages in cardio protection. Combination therapy demonstrates the potential for synergy.
Conclusion: GLP-1RA is the second-line medication after metformin in women with PCOS and obesity. SGLT2 inhibitors should be recommended for patients with prediabetes or type 2 diabetes and when patients need cardio protection. The integration of these groups of medications into clinical practice requires a personalized approach.

Authors’ contributions: Sheshukova N.A., Levakov S.A. – developing the concept of the study; Shipilova G.A., Konakova I.V.,
Ter-Ovanesova O.A. – collecting and processing the materials, writing the text; Sheshukova N.A. – editing the text.
Conflicts of interest: The authors declare no possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Shipilova G.A., Konakova I.V., Ter-Ovanesova O.A., Sheshukova N.A., Levakov S.A.
Effectiveness and safety of glucagon-like peptide-1 receptor agonists and sodium-glucose
cotransporter 2 inhibitors in women with polycystic ovary syndrome and obesity.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (3): 45-51 (in Russian)
https://dx.doi.org/10.18565/aig.2025.288

polycystic ovary syndrome

obesity

glucagon-like peptide-1 receptor agonists

sodium-glucose cotransporter 2 inhibitors

metformin

exenatide

dapagliflozin

empagliflozin

Full text (in Russian)

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Received 13.10.2025

Accepted 26.11.2025

Galina A. Shipilova, student, N.V. Sklifosovsky Institute of Clinical Medicine, Educational Track: Research, I.M. Sechenov First Moscow State Medical University,
Ministry of Health of the Russian Federation (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8, build. 2, Shipilova-25@mail.ru,
https://orcid.org/0009-0003-3082-6989
Irina V. Konakova, student, N.V. Sklifosovsky Institute of Clinical Medicine, Educational Track: Research, I.M. Sechenov First Moscow State Medical University,
Ministry of Health of the Russian Federation (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8, build. 2, Kikisusu@mail.ru,
https://orcid.org/0009-0003-4046-2314
Olga A. Ter-Ovanesova, student, N.V. Sklifosovsky Institute of Clinical Medicine, Educational Track: Research, I.M. Sechenov First Moscow State Medical University,
Ministry of Health of the Russian Federation (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8, build. 2, olgaterovanesova@mail.ru,
https://orcid.org/0009-0006-9621-6763
Natalya A. Sheshukova, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology, N.V. Sklifosovsky Institute of Clinical Medicine,
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), 119991, Russia, Moscow, Trubetskaya str.,
8, build. 2, sheshukova_n_a@staff.sechenov.ru, https://orcid.org/0000-0002-8757-0131
Sergey A. Levakov, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, N.V. Sklifosovsky Institute of Clinical Medicine,
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), levakoff@yandex.ru, 119991, Russia, Moscow, Trubetskaya str.,
8, build. 2, levakoff@yandex.ru, https://orcid.org/0000-0002-4591-838X

Effectiveness and safety of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors in women with polycystic ovary syndrome and obesity

Shipilova G.A., Konakova I.V., Ter-Ovanesova O.A., Sheshukova N.A., Levakov S.A.

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