Demographic characteristics of study subjects.

IntroductionPolycystic Ovary Syndrome (PCOS) is a common endocrine and metabolic disorder characterized by chronic inflammation, insulin resistance, and hormonal imbalances, often leading to infertility and metabolic dysfunction. Metformin, an insulin-sensitizing agent, has shown potential to improve these conditions. This study investigated the impact of metformin on inflammasome-regulating microRNAs (miR-9, miR-223, miR-132) and related genes (IL-1β, IL-18, caspase-1, NLRP3) in obese and non-obese PCOS patients compared to healthy controls.Materials and methodsIn this case-control study, 100 women aged 18–35 were divided into 50 PCOS patients and 50 controls, stratified by BMI (>25 kg/m² and ResultsThe results demonstrated a significantly lower expression of miR-9 in PCOS patients (BMI >25 kg/m²) compared to healthy controls (mean ± SD: 0.54 ± 0.07 vs. 1.00 ± 0.11; P miR-223 expression was significantly upregulated (from 0.88 ± 0.06 to 1.21 ± 0.08; P = 0.002). Similarly, the expression levels of IL-1β (2.01 ± 0.31 vs. 1.31 ± 0.23) and NLRP3 (2.12 ± 0.27 vs. 1.38 ± 0.22) decreased significantly post-treatment (P miR-132 expression. Overall, metformin modulated the expression profiles of inflammasome-related genes and miRNAs, particularly in obese patients with PCOS.ConclusionThe findings suggest that metformin modulates inflammation in PCOS by altering microRNA and inflammasome-related gene expression, thereby reducing inflammatory markers such as IL-1β and miR-9, while enhancing miR-132 and miR-223, which may contribute to improved metabolic and inflammatory profiles. These results support the use of metformin as a BMI-tailored therapeutic strategy for PCOS, warranting further research to confirm its long-term effects and mechanisms.