Polycystic ovary syndrome (PCOS) is a relatively common hormonal disorder that is one of the leading causes of infertility. Some women who have PCOS develop insulin resistance. This occurs when the cells of the body don’t respond well to a hormone known as insulin. Insulin allows the cells to take sugar (glucose) from the blood. If the cells don’t take in this sugar it leads to higher levels of glucose and insulin circulating through the body in the bloodstream. This, in turn, leads to increased levels of androgens (male hormones) which cause the classic symptoms of PCOS such as excess hair growth and more importantly in terms of fertility – lack of ovulation. Getting pregnant with PCOS can be possible with the right diagnosis and treatment plan.
Here are the Top 10 facts about metformin use in PCOS patients:
Metformin is a medication that is primarily used to treat type 2 diabetes. It is marketed in the US under the names Fortamet, Glucophage, Glucophage XR, Glumetza and Riomet. It is available as a tablet, extended-release tablet and a liquid.
With infertility patients, it is used not because the women with PCOS have diabetes (although they do have an increased risk of developing this disease), but because it acts on improving use of insulin by the cells of the body and therefore reducing the level of insulin in the blood. This can lead to improved ovulation, more regular menstrual cycles as well as a reduction in excessive hair growth, acne and weight gain. It may also slow down or prevent the development of type 2 diabetes later in life.
To determine if it would be helpful for a patient with PCOS to use Metformin, they are given a 2 Hour Glucose Tolerance Test. First, a fasting blood sample is drawn to determine a baseline glucose level. The patient then consumes a drink that has a high concentration of sugar. After two hours, the blood test is repeated. If the results indicate that an increased level of glucose is present that indicates that the body is not properly using insulin, and that the patient would benefit from the use of Metformin. If so, additional blood tests are drawn to insure that that the patient’s liver and kidneys are functioning normally.
It is generally safe to take metformin in pregnancy (Pregnancy Category B). Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus. It is also safe to take metformin when breastfeeding.
Proper use. Metformin should be taken with meals to help reduce stomach or bowel side effects that may occur during the first few weeks of treatment.
Swallow the extended-release tablet whole with a full glass of water. Do not crush, break, or chew it.
While taking the extended-release tablet, part of the tablet may pass into your stool after your body has absorbed the medicine. This is normal and nothing to worry about.
Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.
Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.
You may notice improvement in your blood glucose control in 1 to 2 weeks, but the full effect of blood glucose control may take up to 2 to 3 months. Ask your doctor if you have any questions about this.
Dosing. The dose will be different for different patients. The daily dose varies from 500 mg to 2000 mg orally daily. It is usually started a low dose and then very gradually increased to the full dose over a period of about four weeks.
If you miss a dose, please take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to our regular dosing schedule. Do not double doses.
Precautions. Metformin may interact with the dye used for an X-ray or CT scan. Your doctor my advice you to stop taking it before you have any medical exams or diagnostic tests that might cause less urine output than usual. Discuss with your doctor any other medications you are taking as they may interact with metformin.
Drinking alcohol may cause severe low blood sugar. You can have low or high blood sugar levels when on metformin. These can occur with lack of exercise, fever or infection.
Under certain conditions, too much metformin can cause lactic acidosis. The symptoms of lactic acidosis are severe and quick to appear, and usually occur when other health problems not related to the medicine are present and are very severe, such as a heart attack or kidney failure.
Symptoms of lactic acidosis include abdominal or stomach discomfort, decreased appetite; diarrhea; fast or shallow breathing; a general feeling of discomfort; severe muscle pain or cramping; and unusual sleepiness, tiredness, or weakness.
Metformin does have some side effects, including nausea, diarrhea and excess gas. These generally occur only while the body is first getting used to the medication, and then they subside.
Other common side effects include abdominal or stomach discomfort, cough or hoarseness, decreased appetite, fast or shallow breathing, fever or chills, general feeling of discomfort, lower back or side pain, muscle pain or cramping, painful or difficult urination, sleepiness
Metformin is only part of a complete program for controlling diabetes or PCOS. It is important that you always eat a healthy diet, watch your weight, and get regular exercise. If you have been diagnosed with PCOS, you should talk to your physician about how Metformin could be a helpful addition to your infertility treatment and your overall health.
Janet Chiaramonte joined the staff of Invia Fertility as a registered nurse in 2005. Years ago (too many to count), she received her Bachelor's Degree in Psychology, and then worked for a decade at Children's Memorial Hospital in an administrative position. She always wanted to be part of the patient care side of medicine though, so she went back to school and received an Associate's Degree in Nursing.