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Thus, all PROSPERO guidelines were incorporated during the execution of the literature review ( 3 Multifaceted effects of metformin: understanding its pleiotropic properties Metformin provides hypoglycemic effect through various mechanisms, such as inhibition of gluconeogenesis in the liver, increased glucose uptake in skeletal muscle and hepatocytes, decreased glucose absorption in the gastrointestinal tract ( Apart from its hypoglycemic effects, metformin has been shown to have several other beneficial effects on lipid profile, immune and coagulation responses, and hormone synthesis ( Metformin also has a significant impact on the PCOS, decreasing luteinizing hormone and androgen synthesis, resulting in normalizing the menstruation cycle ( The pleiotropic effects of metformin are achieved through its ability to modulate multiple factors at the molecular level

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Meanwhile, metformin effectively inhibited endometrial thickening in PCOS rats, while attenuating the overexpression of GLUT4 in the endometrium (Zhai et al., 2012)