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The carnitines are essential in the metabolism of fatty acids and can act to protect from mitochondrial damage and altered energy balance conditions such as those present in polycystic ovary syndrome (PCOS)

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SGLT2 inhibitors may improve metabolic profiles in selected non-pregnant patients, but any such use must remain strictly outside pregnancy, under reliable contraception, and with guideline-consistent discontinuation before conception attempts because of urogenital adverse effects and contraindications during pregnancy (155, 156)