Table 2. Synthetic agents utilize for PCOS treatment.
Category	Name of Drug	MOA	Side Effects	References
Insulin Sensitizers	Metformin	Promote the absorption of glucose in intestine, ↓ the liver’s synthesis of glucose, ↓ the absorption of glucose in the intestines, and ↓both fasting and post-meal blood glucose levels.	Diarrhea, Flatulence, bloating, anorexia, stomach discomfort, metallic taste in mouth, and nausea	Mathur et al., 2008; Diamanti-Kandarakis et al., 2010; Lashen, 2010; Johnson, 2014; Dumitrescu et al., 2015; Ryssdal et al., 2023
TZDs	Pioglitazone	↓ release of fatty acids, ↓ TNF α-induced inhibition of insulin action	Congestive heart failure	Glintborg & Andersen, 2010; Du et al., 2012; Madnani et al., 2013; Piątkowska-Chmiel et al., 2022)
	Rosiglitazone	↑ transcription of PPAR-γ and ↑ Insulin-induced target cell response	Peripheral Edema
DPP-4 inhibitors	Sitagliptin	↑ incretin levels, ↓ DPP-4 enzyme and ↑ synthesis of insulin by beta cells of pancreas	Angiopathic Edema	Ferjan et al., 2018; Modarres et al., 2023
	Linagliptin and Alogliptin	Weight increase and hyperinsulinemia	Headache, upper respiratory tract infection
GLP-1 agonists	Exenatide	Weight loss, lipogenesis	Injection site reaction	Bednarz et al., 2022
SGLT-2 Inhibitors	Empagliflozin	Obesity, androgen excess, Hyperinsulinemia	Infections of urinary system and female genital mycotic	Cassidy-Vu et al., 2016; Marinkovic-Radosevic et al., 2021
	Dapagliflozin	↓ Renal glucose threshold, ↓ glucose reabsorption from renal tubules	Elevated urination	Elkind-Hirsch et al., 2021
	Canagliflozin	↓intestinal reabsorption of glucose, ↑ incretin secretion	Urinary tract disease, moderate diarrhea, nausea, and a female genital mycotic infection	Zhang et al., 2022
Anti-estrogen	Clomiphene Citrate	Prevents the hypothalamus-pituitary axis from responding to endogenous estrogen in the blood by blocking estrogenic hypothalamic receptors. This, in turn, causes the anterior pituitary to produce FSH in response to changes in GnRH pulsatility.	Impaired vision, nausea and vomiting, breast pain, ovarian enlargement, and abdominal-pelvic discomfort/distention/bloating	Kamath & George, 2011
Aromatase inhibitor	Letrozole	The enzyme aromatase, which helps turn androgens into estrogens, is competitively inhibited by nonsteroidal compounds.	Headache, hot flashes, asthenia, hypercholesterolemia, edema, bone pain, flushing	Pajai et al., 2022
Antiandrogens	Flutamide	reduces androgen synthesis through the restoration of ovulation	Hepatocellular Toxicity	De Leo et al., 1998; Ryan et al., 2018
	Finasteride	impede the activation of DHT by 5 alpha reductases, hence diminishing the impact of androgens.	Sexual dysfunction, depression, erectile dysfunction, loss of libido	Moghetti et al., 1994; Traish, 2020
	Spironolactone	Partial blockage of testosterone production, aromatase stimulation, and androgen receptor blockade	Intermenstrual bleeding	Zulian et al., 2005; Sabbadin et al., 2016)