This systematic review and meta-analysis evaluates the efficacy of anti-obesity agents in managing hormonal, reproductive, metabolic, and psychological outcomes in polycystic ovary syndrome (PCOS). The study included 11 trials with a total of 545 and 451 participants in the intervention and control arms, respectively. Key findings include: 1. **GLP-1 Receptor Agonists (GLP-1 RAs)**: Liraglutide, semaglutide, and orlistat showed superior anthropometric outcomes compared to placebo. Meta-analyses found no significant differences between exenatide and metformin for anthropometric, biochemical hyperandrogenism, and metabolic outcomes, except for lower fasting blood glucose with metformin. Orlistat combined with a combined oral contraceptive pill (COCP) did not improve metabolic outcomes compared to COCP alone. 2. **Exenatide**: Compared to metformin, exenatide was superior for insulin area under the curve and the Matsuda index but showed more gastrointestinal adverse events. 3. **Liraglutide**: Liraglutide was superior to placebo for most anthropometric outcomes, including weight, BMI, waist circumference, and fat mass. It also showed benefits for some hormonal outcomes and menstrual frequency. 4. **Semaglutide**: Semaglutide was superior to placebo for all anthropometric outcomes, including body weight, BMI, waist circumference, and visceral body fat. It also showed benefits for fasting insulin and HDL cholesterol. 5. **Orlistat**: Orlistat was superior to COCP alone for some anthropometric outcomes but not for metabolic outcomes. Meta-analyses found no differences between orlistat + lifestyle + COCP and lifestyle + COCP for metabolic outcomes. The review highlights the need for further high-quality, multicenter studies to evaluate the efficacy and safety of these agents in PCOS, particularly focusing on reproductive, metabolic, and psychological outcomes. The findings suggest that anti-obesity medications, including liraglutide, semaglutide, GLP-1 RAs, and orlistat, could be considered for managing higher weight in adult women with PCOS, alongside active lifestyle interventions.This systematic review and meta-analysis evaluates the efficacy of anti-obesity agents in managing hormonal, reproductive, metabolic, and psychological outcomes in polycystic ovary syndrome (PCOS). The study included 11 trials with a total of 545 and 451 participants in the intervention and control arms, respectively. Key findings include: 1. **GLP-1 Receptor Agonists (GLP-1 RAs)**: Liraglutide, semaglutide, and orlistat showed superior anthropometric outcomes compared to placebo. Meta-analyses found no significant differences between exenatide and metformin for anthropometric, biochemical hyperandrogenism, and metabolic outcomes, except for lower fasting blood glucose with metformin. Orlistat combined with a combined oral contraceptive pill (COCP) did not improve metabolic outcomes compared to COCP alone. 2. **Exenatide**: Compared to metformin, exenatide was superior for insulin area under the curve and the Matsuda index but showed more gastrointestinal adverse events. 3. **Liraglutide**: Liraglutide was superior to placebo for most anthropometric outcomes, including weight, BMI, waist circumference, and fat mass. It also showed benefits for some hormonal outcomes and menstrual frequency. 4. **Semaglutide**: Semaglutide was superior to placebo for all anthropometric outcomes, including body weight, BMI, waist circumference, and visceral body fat. It also showed benefits for fasting insulin and HDL cholesterol. 5. **Orlistat**: Orlistat was superior to COCP alone for some anthropometric outcomes but not for metabolic outcomes. Meta-analyses found no differences between orlistat + lifestyle + COCP and lifestyle + COCP for metabolic outcomes. The review highlights the need for further high-quality, multicenter studies to evaluate the efficacy and safety of these agents in PCOS, particularly focusing on reproductive, metabolic, and psychological outcomes. The findings suggest that anti-obesity medications, including liraglutide, semaglutide, GLP-1 RAs, and orlistat, could be considered for managing higher weight in adult women with PCOS, alongside active lifestyle interventions.