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Life sciences · Journal article
Journal of Association of Clinical Endocrinologist and Diabetologist of Bangladesh · October 5, 2026
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Background: Obesity exacerbates metabolic and androgenic abnormalities in polycystic ovary syndrome (PCOS). Although metformin is widely used, its effects on weight and metabolic dysfunction are modest. Semaglutide may offer additional benefit, but evidence in South Asian women with PCOS and obesity is limited. Objective: To evaluate the efficacy and safety of low-dose semaglutide added to metformin compared with metformin alone in women with PCOS and obesity. Methods: In this randomized controlled trial, 31 reproductive-age Bangladeshi women with PCOS and obesity were randomized to metformin (1000 mg/day; n=16) or metformin plus semaglutide (1000 mg/day and 0.25 mg/week for 4 weeks, then 0.5 mg/week for 12 weeks; n=15). Both groups received standardized lifestyle modification. Clinical, anthropometric, hormonal, and metabolic parameters were assessed at baseline and at 16 weeks, with interim clinical assessments at weeks 4, 8, and 12. Results: Compared with metformin alone, combination therapy led to greater weight loss (p=0.001), with ≥5% weight loss achieved by 93.3% versus 43.8% of participants (p=0.006). Waist circumference decreased more with combination therapy (p<0.001). Total testosterone (p=0.003), free androgen index (p=0.004), and insulin resistance indices (p=0.018) improved significantly more with combination therapy. Diastolic blood pressure decreased significantly only in the combination group (p=0.016). Adverse events were more frequent with combination therapy (86.7% vs. 31.3%), predominantly gastrointestinal and transient; none required treatment discontinuation. Conclusion: In women with PCOS and obesity, adding low-dose semaglutide to metformin over 16 weeks produced greater improvements in weight, central adiposity, androgenic profile, insulin resistance, and diastolic blood pressure than metformin alone. The findings support further adequately powered, longer-term trials evaluating this combination in South Asian populations. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2026;5(Suppl 1): S35]