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There is increasing interest in the use of Metformin in women with PCOS.
Several studies have recorded the use of Metformin in women with PCOS. Metformin is effective in reducing testosterone levels and in making the menstrual cycle more regular.
While metformin starts to improve the prospects for fertility in few weeks, a reduction in unwanted hair growth would be expected to take some months and be slower than conventional treatment.
Women can find weight loss easier when taking PCOS metformin even though it is not a traditional weight reducing agent. One placebo-controlled trail has shown that Metformin is better than placebo in inducing ovulation in women with PCOS. This drug has been best demonstrated in obese women and it is likely that non-obese women would benefit less from this drug.
Side effects
Serious side effects to Metformin treatment are very rare. In particular, Metformin does not cause hypoglycaemia. In the first week of taking Metformin, an upset stomach or diarrhoea is common and this side effect can be reduced by taking it after food and by starting with a very low dose (250 mg) and to increase slowly by 250 mg per week until the full dose of 1700 mg is achieved (850 mg twice per day).
Women who have kidney damage are at an increased risk of a very rare side effect of Metformin therapy called lactic acidosis. The drug should be given cautiously, if at all, in this instance. While safety during pregnancy has not yet been established, many women over the years have inadvertently taken Metformin when pregnant and no adverse effects have been reported. Indeed, one group has reported the intentional use of Metformin to treat diabetes throughout pregnancy.
Metformin can interfere with the absorption of Vitamin B12 in a small percentage of patients. Therefore, Serum B12 concentration should be checked every six months. By increasing dietary intake of calcium may prevent Metformin influence on B12 absorption. Blood tests for liver function should also be checked at least yearly. In rare cases the patient may experience sensitivity to sunlight.
Criteria for the use of Metformin
- Established diagnosis of PCOS.
- Body mass index over 30 km/m2 or BMI < 30 and gaining weight.
Metformin comes in two sizes of tablet 500 and 850 mg. Take tablets after food - if side effects are encountered then stop the increase in dosage at the last acceptable level.
PCOS Metformin works much better if combined with a strict regime of diet and exercise. Diet should be at least three light meals per day which are low in sugar and fat and high in fruit, fresh vegetables and salad. Light sustained exercise such as walking, cycling or swimming for at least an hour at a time several times per week.
Daily dose – to avoid side effects
Week 1 250 mg once
Week 2 250 mg twice
Week 3 500 mg + 250 mg
Week 4 500 mg twice
Week 5 850 mg + 500 mg
Week 6 850 mg twice
Monitoring the use of Metformin
Tests at the start of Metformin and every 2 months thereafter Menstrual cycle diary for 6 months (recall), Weight, Urinalysis LH, FSH, Testosterone, Glucose, HbA1c, U&E, Cholesterol, triglycerides, HDL, LDL – fasting insulin is optional. Stop taking Metformin if pregnancy occurs.
There is no particular time limit for the use of PCOS Metformin - if no effect is seen in six months then there is no point in continuing. After one year the goals of future treatment should be reviewed.
The long term place of PCOS Metformin is not clear. It is strongly recommended that the use of Metformin is monitored either in an official trail or as a formal audit in a specialist unit in order that the effectiveness of this treatment can be clearly documented.
Alternatively, you can avoid the side effects of using PCOS metformin and follow a more natural PCOS treatment.
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