Adjunctive berberine improves hormonal, metabolic, and inflammatory profiles in women with polycystic ovary syndrome: a retrospective case–control study

Background: Polycystic ovary syndrome (PCOS) is often associated with androgen excess, insulin resistance, and low-grade inflammation. While progesterone is standard for regulating menstrual cycles, additional therapies are often needed to address metabolic and inflammatory dysfunctions. Berberine has shown insulin-sensitizing and anti-inflammatory actions that may complement standard hormonal therapy. Objectives: This study was designed to evaluate whether adding oral berberine to luteal-phase progesterone improves anthropometric, hormonal, metabolic, and inflammatory indicators in women with PCOS compared with progesterone alone. Methods: Women with PCOS who received either berberine plus luteal-phase progesterone or progesterone alone for 3 months were retrospectively analyzed. Clinical records were reviewed for anthropometric, hormonal, metabolic, and inflammatory outcomes, assessed at baseline and after treatment. Results: The berberine group showed significant within-group reductions in weight, BMI, and WHR; no significant changes occurred in the controls. Crude post-treatment between-group differences in weight, BMI, and WHR were not significant, but became significant for weight and BMI after adjustment. Although the LH and LH/FSH ratio declined in both groups, the adjusted post-treatment values were significantly lower in the berberine group compared to the control group, indicating a superior effect. Total testosterone fell only in the berberine group, yielding significant crude and adjusted between-group differences. Metabolically, fasting insulin, FBS, and HOMA-IR decreased significantly in the berberine group but not in the control group, with crude and adjusted between-group differences remaining significant. Inflammatory markers (CRP, TNF-α, IL-6) declined significantly only in the berberine group. Between-group comparisons were significant in CRP, TNF-α, and IL-6 at 3 months after adjustment. Conclusions: These preliminary findings suggest that adjunctive berberine therapy may improve anthropometric, hormonal, metabolic, and inflammatory profiles in women with PCOS. However, well-designed randomized controlled trials are required to confirm these effects and establish definitive clinical recommendations.