The COMET-PCOS randomized clinical trial investigated the effect of low-dose combined hormonal contraception (COCP), metformin and their combination on the prevalence of the metabolic syndrome (MetS) in women with hyperandrogenic polycystic ovary syndrome (PCOS) and obesity. The study enrolled 240 women aged 18–40 years with a BMI of 25–48 kg/m², with 169 participants completing the 24-week follow-up. At baseline, the prevalence of MetS was 31%, and at the end of the study, there were no statistically significant differences in the prevalence of MetS among the three treatment groups: metformin 26.2%, combination therapy 28.6%, and COCP 28.8% (p = 0.26). There was a significant reduction in waist circumference of 2.23 cm and BMI of 0.49 kg/m² in the COCP group, while no significant changes were noted in the metformin group. Side effects in the metformin and combination treatment groups included diarrhea in more than 64% of participants, and uterine bleeding in 24.1% in the COCP group. The study suggests that low-dose COCPs are effective in managing PCOS symptoms without increasing the risk of metabolic syndrome, whereas metformin alone or in combination has not been shown to reduce cardiometabolic risk. The main limitation was possible insufficient power to detect differences in secondary outcomes[6].