Metformin for the treatment of PCOS

DID YOU KNOW? Most people don’t need sugars in their diet to maintain a healthy blood glucose level (unless you are hypoglycemic or diabetic). This is because your liver can create glucose on its own to be released in the blood to keep you healthy. Understanding this concept is essential for understanding the role Metformin plays in your PCOS treatment.

Metformin, also known as Glucophage, is a medication commonly used in the treatment of type II diabetes and blood sugar regulation disorders, such as Polycystic Ovary Syndrome. It inhibits the production of glucose in the liver (glucose = a kind of sugar and the fuel of all your body’s cells) and increases insulin sensitivity (insulin = the hormone that tells your body to open up an accept the fuel; if that fuel can’t be used, this hormone is also responsible for fat storage). Metformin is of great utility in non-diabetic women who have PCOS and has demonstrated long-term improvements in weight loss, ovulation, period regularity, hair loss, and body hair growth. Metformin is also effective at helping ease the intense sugar cravings associated with disorders of insulin resistance, such as PCOS and type II diabetes.

DID YOU KNOW? Contrary to popular belief, Metformin DOES NOT lower the impact foods you eat have on your blood sugar. Instead, Metformin tells your liver to stop making sugar (glucogenesis) in response to your body’s signals related to its insulin resistance. This means that you cannot get away with eating more sugar just because you’re on this pill; taking more of it in response to poor dietary choices will probably only make you feel sicker.

A glucose tolerance test is done before you start metformin. In most patients over 17 years old, the usual starting dose is 500 mg a day, which is increased to twice a day and then increased to 850 mg, twice a day. The first dose is taken in the morning after breakfast and the second at night, after dinner. Doses increase until you reach the maximum dose of 2500 mg per day.

DID YOU KNOW? 2000 mg – 2500 mg a day is considered a prophylactic dosage – meaning it will help prevent PCOS from progressing rather than curing it. This often exceeds the dose given to type II diabetics!

Side effects
Metformin is a modern wonder drug but the side effects can be daunting, particularly when you first start taking it. This is medication women with PCOS stop taking on their own against their doctor’s advice because it is not a pill you can feel working instantly. It is not psychoreactive (there’s no high associated with it) and it prevents the onset of worsened disease rather than curing something. This means that the positive effects are not always obvious to the person taking it, making it often difficult to justify enduring the side effects.

DID YOU KNOW? You need to build up a tolerance to this medication in your liver before the side effects will diminish. If you start and stop only to start again, you will be met head on at every false start with the full impact of these side effects!

The most common side effect that patients experience when they start metformin are stomach upset and diarrhea. These symptoms are most acute when you begin your Metformin regimen and they generally subside when you achieve tolerance to the medication. Tolerance usually sets in about a month after you’ve reached the full prophylactic dosage.

You may experience a relapse of these negative side effects if you eat a meal high in simple sugars or fructose. This is similar to the “dumping syndrome” experienced by bariatric weight loss surgery patients. Believe it or not, this is a signal that your Metformin is doing a good job of sensitizing your liver to the sugars in the food you eat. These foods may also begin to change flavor – and certain hyper sweet foods may even start to taste bad to you!

DID YOU KNOW? Dietary changes are a MUST whenever you start a Metformin regimen to best avoid digestive problems. A low carbohydrate diet low in processed convenience foods, in combination with your Metformin, is generally your best bet for defeating sugar cravings and getting your health back on track.

Other side effects are headache, weakness, intestinal gas and abdominal pain. These symptoms can be relieved by taking the medication with a meal. Talk to your doctor about switching to the time released version of this medication if the symptoms persist after tolerance is reached. The time released version is called Metformin ER and it is often much easier on your digestion than the instant release pill form.

Metformin with other treatments
Metformin can be used successfully in combination with other. Spironolactone (Aldactone) is another medication commonly prescribed in combination with Metformin for the treatment of PCOS. The success of metformin treatment increases when patients follow a healthy diet. Since obesity is a common symptom of polycystic ovarian syndrome, many doctors pair their patients with a nutritionist. Regular exercise helps lose weight and improves overall health because it helps the Metformin do a better job of sensitizing your body to glucose in the blood.

In conclusion, Metformin constitutes a fundamental, almost universally accepted treatment in patients with PCOS in any clinical presentation. Metformin regulates the menstrual cycle and induces spontaneous ovulation, thereby increasing fertility and overall health in the process.

DID YOU KNOW? Metformin presents benefits for improving metabolic syndrome, blood glucose levels, total cholesterol, LDL (bad cholesterol), and blood triglycerides. While you may not see or feel it working for you, you are reducing your heightened risk of cardiovascular diseases and other PCOS complications by taking this pill.

Do you have questions about Metformin or PCOS? We highly recommend talking to your doctor or an Endocrinologist (hormone specialist) to discuss possible diagnosis and treatment options. PCOS is often a diagnosis of exclusion because its symptoms mirror so many other possible conditions – such as Cushing’s Syndrome, hypothyroidism and Hashimoto’s Disease. Working closely with a doctor you trust is an essential part of achieving a correct diagnosis. Your doctor will probably want to rule out these other conditions first before prescribing Metformin or any other treatment to you.

Stay tuned for next week’s installment: Spironolactone

Legal Disclaimer


This article contains general information about medical conditions and treatments.  The information is not medical advice and should not be used to replace the advice of a trained physician. If you have any suspicion that the information in this article may apply to you, be sure to contact your doctor for more details!
References

https://www.healthline.com/health/polycystic-ovary-disease
http://www.acog.org/~/media/For%20Patients/faq121.pdf?dmc=1&ts=20120510T1116545699
http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001408


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