Polycystic ovary syndrome (PCOS), recently renamed polyendocrine metabolic ovarian syndrome (PMOS), affects 170 million women globally and is often accompanied by obesity and various levels of insulin resistance. Incretin-based therapies, including the glucagon-like peptide-1 (GLP-1) receptor agonists liraglutide and semaglutide, and the dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonist tirzepatide, offer a biologically plausible mechanism for targeting metabolic dysfunction in PMOS. This review examines clinical trial evidence on the anthropometric and metabolic effects of incretin-based therapies in this population, including a focus on women of reproductive age, who face distinct challenges related to preconception planning, treatment duration, and post-discontinuation metabolic and weight management. Available literature shows that liraglutide, semaglutide and tirzepatide produce clinically meaningful reductions in body weight, body mass index (BMI), and waist circumference, with some studies also confirming preferential effects on visceral and ectopic fat compartments. Glycaemic and insulin resistance outcomes vary across studies, while lipid and blood pressure effects remain incompletely characterized. Although emerging data suggest that higher-potency agents may yield more consistent weight-loss benefits, available PMOS-specific evidence does not establish comparative metabolic superiority among agents. Interpretation of the available evidence is limited by the predominance of short-term trials at sub-obesity doses, frequent co-administration with metformin, and the absence of phenotype-stratified data, leaving the full metabolic potential of these agents in PMOS incompletely defined. Larger, longer, and higher-dose trials are needed to fully characterize the anthropometric and metabolic potential of these agents in PMOS.
