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These can range from mild skin reactions to severe anaphylaxis

In addition, for PCOS patients with insulin resistance (IR), metformin can effectively reduce hyperglycemia and hyperinsulinemia, improve ovulatory function, reduce androgen levels, control weight and waist circumference gain, and mitigate the risks of diabetes mellitus and cardiovascular disease (Notaro and Neto, 2022)

So that's actually improved access quite a lot

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But the most telling shift isn't the dropouts it's the hoops