PCOS management: Conventional vs contemporary

Polycystic ovary syndrome affects 8-13% of women globally and up to 19.6% in India. It is strongly associated with insulin resistance, present in approximately 95% of obese and 75% of lean women with PCOS, leading to metabolic and reproductive dysfunction. Myo-inositol (MI) and metformin (MET) are widely used insulin-sensitizing therapies, though their comparative efficacy remains variably reported. This review assessed the efficacy and safety of MI-based formulations, metformin, and their combination across metabolic, hormonal, and reproductive outcomes in women with PCOS. A comprehensive search of PubMed, Scopus, and Google Scholar identified randomized controlled trials, observational studies, and meta-analyses published between 2010 and 2025 evaluating MI, MET, or combination therapy. Nine studies met inclusion criteria. Outcomes included hyperandrogenism, insulin resistance, androgen levels, menstrual cyclicity, ovulation, fertility outcomes, and adverse effects. Across studies, MI significantly improved menstrual cyclicity (60-70% restoration), ovulation (?70%), and amenorrhea resolution. MI also reduced fasting insulin and HOMA-IR. Large cohort data showed a 15.1% spontaneous pregnancy rate after 2-3 months of MI therapy. Metformin produced similar metabolic and androgen improvements but was associated with markedly higher gastrointestinal adverse effects (?5-fold higher than MI). MI-based formulations significantly improved hirsutism (p