Background: Polycystic ovarian syndrome (PCOS) is a highly prevalent disease that effects both metabolic and reproductive systems in women. PCOS is associated with a high incidence of obesity, insulin resistance, hyperandrogenism, hyperlipidemia, menstrual cycle dysfunction, and infertility. Diagnosis is made using the Rotterdam Criteria, and current accepted medical management of PCOS includes lifestyle changes such as diet and exercise, oral contraceptive pills (OCP), metformin (MET), and bariatric surgery. a. The aim of this systematic review is to assess the effect of berberine on waist circumference and cholesterol levels.
Methods: A comprehensive literature search was done using Medline, Web of Science, and Clinical key using keywords PCOS or polycystic ovarian syndrome and berberine. Relevant studies were critically assessed using GRADE.
Results: Two studies were chosen for this systematic review, one randomized control trial, and one case control study, that adequately assessed the effects of berberine compared to metformin as well as alone for the treatment of PCOS. The RCT showed that BBR appears to have greater effect than metformin on decreasing waist circumference and waist-to-hip ratio, total cholesterol, triglycerides, and low-density lipoprotein after 3 months of treatment. The case control study showed that BBR therapy caused a statistically significant decrease in waist circumference, LDL levels, and triglycerides in women with PCOS after 6 months of treatment. These studies resulted in a low quality of evidence overall.
Conclusion: BBR caused a greater decrease in waist circumference and lipid profile than MET. This effect is additive when combined with lifestyle changes such as diet and exercise. More studies are needed to evaluate the long-term efficacy of BBR on weight loss and BMI. Overall as weak recommendation, berberine can be considered as a suitable alternative to metformin for the treatment of polycystic ovarian disease.
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