Comparative Effectiveness and Safety of East Asian Traditional Medicine for Adolescents with Polycystic Ovary Syndrome: A Protocol for Systematic Review and Bayesian Network Meta-Analysis

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Abstract
Objectives: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in adolescents with significant reproductive and metabolic implications. Although East Asian traditional medicine (EATM) has shown potential in managing PCOS, no study has comprehensively compared its modalities in adolescents.Methods: This protocol outlines a Bayesian network meta-analysis of randomized controlled trials assessing herbal medicine, acupuncture, and other EATM interventions versus conventional treatment or placebo in adolescents (≤19 years) diagnosed with PCOS. Comprehensive database searches will include PubMed, Embase, CENTRAL, and East Asian sources. Risk of bias will be evaluated using RoB2, and the certainty of evidence using CINeMA.Results: The primary outcome will be improvement in menstrual irregularity, assessed by cycle frequency, duration, and regularity. Secondary outcomes will include changes in serum hormone levels (luteinizing hormone, follicle-stimulating hormone, estradiol, testosterone, anti-Müllerian hormone) and the incidence of treatment-related adverse events. Comparative effectiveness and safety will be estimated using a Bayesian network meta-analysis under a random-effects model; the analysis will report mean differences with 95% credible intervals, assess inconsistency with node-splitting and heterogeneity with χ² (Q), τ², and I², and rank interventions via the surface under the cumulative ranking curve.Conclusions: This review will be the first to provide a ranked comparison of EATM interventions in adolescent PCOS. The findings are expected to guide clinical decision-making, promote safer and more effective individualized care, and support integrative approaches in adolescent PCOS management.

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