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Berberine regulates glucose metabolism by supporting GLP-1 receptor production and inhibiting GLP-1 breakdown, which may help support an insulin response to a meal

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Transdermal estrogen bypasses this pathway and is therefore associated with lower thrombotic risk, making it a preferred option for many women, particularly those with elevated baseline risk [27]

Even the GLP-1 receptor agonist class, which has actual PCOS trial data and long-standing approvals for diabetes and obesity, is used in PCOS only off-label and with explicit acknowledgment of limited evidence

Deng, C