Gynecological endocrinology : the official journal of the International Society of Gynecological EndocrinologyJun 8, 2023

Gut bacteria changes in obese PCOS patients treated with metformin alone or combined with exenatide

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Updated Apr 2, 2026

Abstract

In a study of 29 patients with obesity and polycystic ovary syndrome, both exenatide combined with metformin and metformin alone improved metabolic markers and gut microbiota composition.

Body mass index (BMI), total testosterone (TT), HbA1c, and HDL cholesterol levels were significantly improved in both treatment groups.
Both groups showed an increase in the abundance of specific gut bacteria, such as Bacteroidetes and certain probiotics, after treatment.
Distinct differences in gut microbial species were observed between the two groups; for example, Clostridium and Fusobacterium predominated in the metformin group.
The combination treatment resulted in a higher presence of probiotic species, including Bifidobacterium and Prevotella, compared to metformin alone.
Both treatment regimens positively affected the diversity and abundance of intestinal flora in patients with obesity and PCOS.

Simplified

OBJECTIVE: To investigate the effect of exenatide treatment on the composition of intestinal flora and metabolic pathways in patients with obesity with polycystic ovary syndrome.

METHODS: Patients with obesity with polycystic ovary syndrome (PCOS) were distributed to two groups: one received exenatide combined with metformin (COM group, = 14) and the other used metformin alone (MF group, = 15). Fresh fecal specimens from the participants, including 29 patients with obesity with PCOS and 6 healthy controls, were collected for metagenomic sequencing. The effect of exenatide combination with metformin or metformin alone on the composition and function of intestinal flora in patients with obesity with PCOS were compared by bioinformatics analysis. n n

RESULTS: The level of BMI, TT, HbA1c, and HDL-c was significantly improved in both groups. The MF and COM groups were abundant in Firmicutes, Bacteroidetes, Uroviricota, Actinobacteria, and Proteobacteria. Abundance of Bacteroidetes, Proteobacteria, Hungatella, and certain probiotics like Phocaeicola and Anaerobutyricum significantly increased in both groups after treatment. Enriched microbial species in the MF and COM group were different. Clostridium, Fusobacterium, and Oxalobacter were the main bacteria in the post-MF group, while,, and_sp_AF16_5 were the main bacteria in the post-COM group. The post-COM group had more probiotic species including Bifidobacterium, Prevotella, and Anaerobutyricum after treatment. Lactococcus_garvieae Clostridium_perfringens Coprococcus

CONCLUSION: Both exenatide combined with metformin and metformin monotherapy can improve metabolic and endocrine markers, and the diversity and abundance of gut microbiota in patients with obesity with PCOS. The effects of the combination and monotherapy agents on intestinal flora were consistent to some extent but also unique respectively.

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Gut bacteria changes in obese PCOS patients treated with metformin alone or combined with exenatide

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