Effect of Metformin Iontophoresis on Knee Osteoarthritis in Postmenopausal Women

Inclusion Criteria: * • Postmenopausal women aged 50-70 years. * Clinical and radiographic diagnosis of knee osteoarthritis according to the American College of Rheumatology criteria. * Radiographic severity classified as Kellgren-Lawrence grade II or III. * Chronic knee pain for a duration of at least 3 months. * Pain intensity ≥4 on the Visual Analog Scale. * Ability to ambulate independently with or without assistive devices. * Ability to understand and follow instructions. * Willingness to participate and provide written informed consent. Exclusion Criteria: * • Severe knee osteoarthritis (Kellgren-Lawrence grade IV). * History of knee surgery or intra-articular injections within the previous 6 months. * Presence of inflammatory rheumatic diseases such as rheumatoid arthritis or gout. * Neurological disorders affecting lower limb function. * Uncontrolled metabolic, cardiovascular, or systemic diseases. * Current or recent use of metformin or other antidiabetic medications. * Skin lesions, infections, or hypersensitivity at the iontophoresis site. * Contraindications to electrotherapy such as pacemakers or implanted electronic devices. * Body mass index ≥35 kg/m². * Participation in another clinical trial within the last 3 months.