Thiazolidinediones

Thiazolidinediones (TZDs), including pioglitazone and rosiglitazone, are a class of insulin-sensitizing medications that work by activating PPAR-gamma receptors in fat cells, muscle, and liver to enhance glucose uptake and improve insulin sensitivity. While effective at reducing insulin resistance and improving metabolic markers in PCOS, TZDs have largely been replaced by metformin as the preferred insulin sensitizer due to side effects including weight gain, fluid retention, and concerns about long-term cardiovascular effects. They may still be considered in select PCOS cases where metformin is not tolerated or insufficient on its own.