Metformin for the Treatment of the Polycystic Ovary Syndrome

Symptoms of Polycystic Ovary Syndrome:

Polycystic ovary syndrome (PCOS) is diagnosed by the presence of two or more of the following symptoms:

  • Oligo-ovulation (less than monthly ovulation) or anovulation (no ovulation)
  • Androgen excess (usually in the form of high testosterone levels)
  • Polycystic ovaries (enlarged ovaries with many cysts)

Common symptoms as a result of the above include: irregular menstrual cycle, hirsutism (abnormal hair growth in a male pattern), acne, and alopecia (loss of hair).

Treating Polycystic Ovarian Syndrome with Metformin:

Many people with PCOS have insulin resistance, and therefore may find relief from their symptoms from medications that are used for diabetes.

Metformin is often used to treat type 2 diabetes because it stops glucose production in the liver and also increases the sensitivity of nearby tissues to insulin. It has now been found that Metformin may also be able to increase ovulation, improve menstrual cycles, reduce androgen levels, and improve hirsutism.

To minimize side effects, patients are usually started at a low dose and gradually increased to the desired maintenance dose.  They are also told to take their Metformin with food.  Some side effects that are common with Metformin use are: nausea, diarrhea, and poor absorption of vitamin B12.

When Metformin is prescribed, patients are often given advice on diet and exercise as well. They may also be given a menstrual record card to keep track of their menstrual cycle. If the patient is sexually active, fertility may resume relatively quickly.  Thus, if pregnancy is not desired, contraception must be initiated.

When starting Metformin, patients are usually asked to follow up with their physician after 3 and 6 months. At these appointments, the physician will often review the patient's menstrual cycle record and order labwork. In addition to this, they may be able to determine whether or not the patient is ovulating by ordering bloodwork to check their progesterone level 7 days prior to the beginning of their next menses.

Please consult your physician if you have further questions regarding the treatment of PCOS.

Information taken from: The New England Journal of Medicine Jan 3 2008; 358: 47-54

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