Overweight or obese women with polycystic ovary syndrome (PCOS) frequently exhibit metabolic disturbances and reproductive dysfunction. This systematic review and meta-analysis evaluated the efficacy and safety of liraglutide in improving metabolic and reproductive outcomes in this population. PubMed, Embase, the Cochrane Library, Scopus, Web of Science and ClinicalTrials.gov were systematically searched from inception to 31 May 2025 for randomized controlled trials (RCTs) comparing liraglutide (alone or in combination) with placebo, metformin or non-liraglutide active treatments in overweight or obese women with PCOS. Two reviewers independently conducted study selection, data extraction and risk-of-bias assessment. Pooled analyses were performed using a random-effects model, and results were expressed as Hedges' g or odds ratios (ORs) with 95% confidence intervals (CIs). Seven RCTs comprising 330 women with PCOS were included. Compared with control treatments, liraglutide significantly increased menstrual frequency (g = 1.76; 95% CI [0.28, 3.24]), reduced body mass index (BMI; g = -0.52; [-0.94, -0.10]) and improved insulin resistance (homeostatic model assessment of insulin resistance; g = -0.52; [-0.83, -0.22]), lowered luteinizing hormone and free androgen index and modestly increased sex hormone-binding globulin levels. Heterogeneity was high for menstrual frequency. Reproductive outcomes such as ovulation and pregnancy could not be pooled due to insufficient reporting. Liraglutide was generally well tolerated, with adverse events consisting mainly of mild gastrointestinal symptoms. Liraglutide therapy improved BMI, insulin sensitivity and menstrual regularity in overweight or obese women with PCOS, suggesting concurrent metabolic and reproductive benefits. However, larger and longer-term trials are warranted to validate its reproductive efficacy and safety profile.
