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Role of metformin in the treatment of PCOS

There is a dilemma if metformin is safe and effective in the treatment of PCOS and a lot of times my clients are confused if they should consume the medication for the management for PCOS.

Here is all the information you need about this drug, its role in PCOS, side effects and if you should be consuming this.

What is Metformin?

Metformin, which is also sold under the trade name Glucophage, stimulates the production of glucose in the liver. It is the primary medication for the treatment of type 2 diabetes, particularly in people who are overweight. It is also recommended in the treatment of Polycystic ovary syndrome (PCOS). Metformin, an insulin-sensitizing agent, has been proven to be of clinical usefulness both in the short-term aiding of infertility treatments and, potentially, in the prevention of the long-term sequelae for patients with PCOS. (HS Wang, Chang Gung medical journal, 2006)

How does Metformin work?

This medicine works by reducing the glucose production by the liver, by increasing the insulin sensitivity of body tissues, and reducing appetite and caloric intake. It decreases the amount of glucose that our bodies absorb from the foods we eat. It helps in decreasing the absorption of carbohydrates we consume. Basically, it helps the cells in the body to absorb the glucose that is already present in it.

Why is it recommended?

Metformin may provide many health benefits for people with PCOS. It can help lower the cholesterol and blood fat levels in the body and decrease the risk of heart disease. One of the many symptoms of PCOS is problems with ovulation and irregular menstrual cycles which in turn makes it difficult to conceive. Metformin can facilitate ovulation and normalize menstruation; it may also lower the risk of miscarriage. It can also help in delaying or preventing diabetes in individuals with PCOS who are overweight.

Health Benefits of PCOS

Most people with polycystic ovary syndrome (PCOS) have insulin resistance or high insulin. Insulin is a hormone produced in the pancreas, which regulates the amount of glucose in the blood. High insulin is a symptom of PCOS. Getting tested for insulin resistance can prove helpful to cancel out other conditions that are commonly mistook as PCOS. According to health specialists, 70% of PCOS patients have insulin resistant PCOS, which can be treated using Metformin, whereas the other types of PCOS like adrenal, inflammatory and post pill are not insulin resistant. Hence, metformin is effective only when the PCOS is insulin resistant.

When should you take it and when can you avoid it?

“Since metformin is well-established with a good safety profile, it is highly recommended to start it early in the management of PCOS,” Dr. Laurence Gerlis, a general practitioner in London advises. Gradually increasing your metformin dose over several weeks can help you avoid its side effects. It should be taken along with food to minimize its side effects. However, one should avoid eating sugary and processed foods, as they can worsen the digestive side effects of the medication.

If one has serious kidney problems, they shouldn’t take metformin. Drinking alcohol while on metformin, and especially binge drinking, can increase one’s risk of lactic acidosis.

Side effects of Metformin

Mostly, people can tolerate this medicine. Though it could cause side effects to some, which mostly tend to be mild and occur initially. A few of them include :

Gastrointestinal Issues: Commonly viewed effects are Diarrhea, Gas, Nausea, Stomach Ache and Bloating. 

Lactic Acidosis: It is the most serious side effect of metformin. It is a potentially life-threatening condition caused by the buildup of lactic acid in the blood. It occurs because of too much metformin accumulation in the blood due to overdose or chronic or acute kidney problems. It causes Nausea, Vomiting, Weakness, etc.

Vitamin B12 deficiency: It causes mood changes, memory loss and damage to the nervous system, caused by long term or high dosage of metformin.

Pros and cons of Metformin

Metformin helps in treating PCOS symptoms, such as irregular ovulation or menstrual cycles, and the excess of insulin present in the body. It is known to treat PCOS symptoms by reducing body mass index (BMI) and hormone levels. Additionally, it assists fertility and increases the chance of successful pregnancy and reduces the risk of early miscarriage, diabetes that occurs during pregnancy, and inflammation associated with PCOS. Metformin is hence used as the drug of choice for the treatment of PCOS.

Metformin, the drug initially approved and consumed for the treatment of Type 2 diabetes mellitus has been proven to be effective in many other conditions such as excessive secretion of ovarian androgens, polycystic ovary syndrome (PCOS), cancer treatment etc.

Along with its excellent pros it also proves to be a problem at times. Metformin has its side effects, in which some could be life threatening and chronic. Metformin is advised to be temporarily discontinued before any procedures like CT Scans or angiogram due to the increased risk of lactic acidosis resulting from damaged kidney function.

My verdict on the use of Metformin

In practice, at the initial stages of PCOS, which can be reversed with lifestyle changes, we work with the medical practitioner and then take a conscious call to avoid it and allow reversal with natural means. We have a specialized 90 days PCOS reversal program which tries to reverse PCOS with diet and lifestyle modification

In severe cases i.e., high BMI (obese or morbidly obese) or visible symptoms of PCOS which are persistent over a period of time or Amenorrhea the PCOS drug is started along with a lifestyle modification and weaned off later.

Hope this information helps you to take a decision if you need Metformin for the treatment of PCOS. Do let us know your queries in the comments section.

FEATURED IMAGE COURTESY Photo by The Tonik on Unsplash





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