Abstract Context: Polycystic ovary syndrome (PCOS) is a heterogeneous condition affecting women of the reproductive age. PCOS is associated with altered anthropometric parameters, a high risk of insulin resistance, increased risks of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Objective: To provide an overview of the existing evidence on the effects of differing pharmacological interventions on the anthropometric outcomes (body weight, body mass index (BMI), waist circumference (WC) and waist to hip ratio (WHR)) in women with PCOS. Data sources: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane Library, and Web of Science in April 2020. A search update in PubMed and a search in grey sources were conducted in March 2021. Study selection: The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).Two reviewers independently assessed titles, abstracts and the full text articles reporting randomised controlled trials (RCTs) of pharmacological interventions in women with PCOS using Covidence software. Data extraction and evidence synthesis: Extracted data was assessed for the risk of bias (RoB) using the Cochrane RoB tool and the evidence graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The inverse-variance random-effects model was used to pool the mean difference of the effect estimates. Heterogeneity and publication bias were assessed. Subgroup analysis according to the type, duration, and dosage of the of pharmacological intervention, was performed. Results: 80 RCTs were included in the meta-analysis. Metformin showed a significant reduction in the mean body weight (-3.13 kgs,95 % CI: - 5.33, -0.93, I²= 5%, moderate grade evidence) and mean BMI (-0.75 kg/m2 ,95% CI: -1.15, -0.36, I²= 0%, moderate grade evidence) compared with placebo. There was also a significant reduction in the mean BMI with orlistat (-1.33 kg/m² ,95% CI: -2.16 -0.66, I²= 0.0%) and acarbose (-1.26 kg/m² , 95% CI: -2.13, -0.38, I²= 0%) whereas BMI increased with pioglitazone by 2.59 kg/m² (95% CI: 1.78, 3.38, I²= 0%) compared to placebo. There was also significant reduction in the mean BMI (-0.91 kg/m², 95% CI: -1.62, -0.19, I²= 0%) when Metformin compared with pioglitazone, and (-3.94 kg/m²,95% CI: -7.81, -0.08 I²= 0.0%) when metformin + sitagliptin compared...