Meta-analysis of the effects of semaglutide on body mass index (BMI) and blood lipid levels in polycystic ovary syndrome patients

Polycystic ovary syndrome (PCOS) is a common endocrine–metabolic disorder in reproductive-aged women, often associated with obesity and dyslipidemia. Semaglutide, a GLP-1 receptor agonist (GLP-1 RA), improves glycemic control and weight, but its effects on PCOS remain unclear. This meta-analysis evaluates semaglutide's impact on BMI and blood lipids in PCOS patients. We searched PubMed, Embase, Cochrane Library, ClinicalTrials.gov, WHO ICTRP, and gray literature sources for RCTs (2010–2025) comparing semaglutide vs. placebo/conventional treatment in PCOS patients. The outcomes included BMI, total cholesterol (TC), triglycerides (TG), LDL-C, and HDL-C. The data were analyzed using RevMan 5.4, with mean differences (MD) and 95% CIs were calculated. Heterogeneity was assessed via I². Eight RCTs (526 patients) were included. Semaglutide significantly reduced BMI (MD: −2.20 kg/m², 95% CI: −2.42 to −1.97, <i>P</i> &lt; 0.001), TC (MD: −0.42 mmol/L, 95% CI: −0.46 to −0.39, <i>P </i>&lt; 0.0001), TG (MD: −0.35 mmol/L, 95% CI: −0.38 to −0.32, <i>P </i>&lt; 0.0001), and LDL-C (MD: −0.31 mmol/L, 95% CI: −0.35 to −0.27, <i>P </i>&lt; 0.0001), but not HDL-C (<i>P</i> = 0.8524). Subgroup analysis showed greater efficacy at doses ≥ 1.0 mg/week and in patients with a baseline BMI &gt; 28 kg/m². Overall evidence quality was moderate to low based on GRADE assessment. Semaglutide significantly improves BMI and lipid profiles in PCOS, particularly at higher doses, and in obese patients. Further long-term studies are needed to confirm safety and reproductive outcomes.