The Combined Effect of N-Acetyl Cysteine and Metformin in Polycystic Ovary Syndrome Patients

Inclusion criteria

• Female aged 20 to 45 years old.
• Confirmed diagnosis with PCOS according to the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS.
• Ability to give informed consent.

Exclusion criteria

• Hypersensitivity to either metformin or NAC.
• Consumption of medications affecting carbohydrate metabolism, such as insulin, sulfonylureas, and taking hormonal analogues two months prior to enrollment.
• Hyperprolactinemia, defined as a prolactin level above laboratory reference range.
• Diabetes mellitus.
• Thyroid dysfunction, subjects with elevated or low TSH level.
• Renal impairment where creatinine clearance (CrCl) less than 30 ml/min.
• Severe hepatic impairment, defined as significant biochemical abnormalities, including hypoalbuminemia and abnormal serum concentration (2-3 times the upper limit of normal), of at least two of the following liver function markers: total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), or gamma-glutamyl transferase (GGT).
• Active alcohol abuse.
• History of lactic acidosis during metformin therapy.
• Active peptic ulcer.
• Congenital adrenal hyperplasia.
• Cushing's syndrome.
• Androgen secreting neoplasia.
• Patients who were using spironolactone, other anti-androgens, or any form of hormone therapy for the treatment of hirsutism at least 3 months before enrollment in the study.
• Decompensated heart failure.