Table 1 PCOS treatment strategies

First-line therapy

Lifestyle modification (Weight loss, exercise, and diet)

Improved body weight, fertility, hormonal profile, and insulin levels

Not effective against moderate to severe symptoms of PCOS [12]

Second-line therapy

MTF (Insulin sensitizer)

Inhibits glucose production in liver, increases peripheral insulin sensitivity and glucose uptake

Nausea, headache, low Vitamin B12, GI disturbance, arrhythmia, cold skin, congenital malformation, and ovarian hyperstimulation syndrome (OHSS) [9, 13]

Third-line therapy

Dipeptidyl peptidase- 4 inhibitors- vildagliptin, sitagliptin, alogliptin, linagliptin, and saxagliptin

Improves insulin sensitivity, hyperandrogenism, and hyperglycemia

Breathing difficulty, headache, hypersensitivity reactions, and pharyngitis [14]