In addition to these findings, other studies have found that there is no consistent evidence that metformin improves the signs of hyperandrogenism.
Metformin should not be completely discounted as an option for the management of PCOS. Whilst less effective than other options, metformin has been shown to restore ovulation in some women with PCOS. For women with PCOS clomiphene citrate is commonly used to induce ovulation, however, not all women respond to treatment with this drug.
For the women that do not respond, it is possible that combination therapy with metformin may be more successful at inducing ovulation. However, the work on this to date is limited. There is a need for longer term studies on metformin, as most studies have only explored short course treatment approaches.
PCOS varies considerably from woman to woman. The presenting symptoms differ in both type and severity, which is why diagnosing it can be so challenging. Women with PCOS are prone to other conditions such as obesity and insulin resistance; they are also at greater risk of developing T2DM and endometrial cancer.
Whether metformin can be given prophylactically to reduce these risks remains unclear and once again highlights the need for longer-term studies with extensive follow-up periods. A more valuable course of action would be for doctors to better understand the various PCOS phenotypes and thus, take a more individualised approach to treatment, deciding which of their patients could genuinely benefit from treatment with the drug.
As a final note, the value of lifestyle modifications should not be understated. Adopting lifestyle changes and losing weight has proven to be, by far, the best approach for managing the symptoms of PCOS.
Medication should remain a contingency strategy for use in those who do respond adequately to lifestyle alterations. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and menopause.
Although metformin can cause side effects, many are mild and occur when first starting to take it. Some of the most common side effects of metformin include:. Slowly increasing your metformin dose over several weeks can help you avoid these issues. If you have ongoing digestive issues, your healthcare provider may switch you to the extended-release version of metformin, which is gentler on the digestive system and better tolerated.
Metformin should be taken with food to minimize side effects. However, you should avoid eating sugary and processed foods, as they can worsen the digestive side effects of the medication. Long-term use and high doses of metformin increase the likelihood of vitamin B12 deficiency. A lack of vitamin B12 can cause mood changes, memory loss, and damage to the nervous system. While taking this drug, you should supplement your diet with vitamin B12 and have your levels checked annually.
Elevated serum homocysteine and urinary methylmalonic acid MMA levels, the gold standard in assessing B12 status, also indicate a B12 deficiency. The most serious side effect of metformin is lactic acidosis, a potentially life-threatening condition caused by the buildup of lactic acid in the blood. This can occur if too much metformin accumulates in the blood due to overdose or chronic or acute kidney problems. If you have serious kidney problems, you shouldn't take metformin.
Drinking alcohol while on metformin, and especially binge drinking, can increase your risk of lactic acidosis. Some medications can also increase the risk, including:. Symptoms of lactic acidosis include:. You can prevent lactic acidosis by:. If you develop symptoms of lactic acidosis, get medical attention right away. There is no natural substitute for metformin.
However, there are natural ways to improve your insulin sensitivity in other ways. The most important things are eating a healthy diet and getting regular physical activity. N-acetyl cysteine is an antioxidant that was shown in one randomized controlled trial to work as well as metformin for reducing insulin resistance and cholesterol in people with PCOS.
Myo-inositol was found to restore ovulation, resulting in more pregnancies than metformin. Myo-inositol has also been shown to improve insulin and other metabolic aspects of PCOS. Regular menstrual cycles usually return within about six months in women with PCOS taking metformin. Some studies have shown that women without PCOS may benefit from using metformin for infertility. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.
American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society disease state clinical review: Guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - part 2. Endocr Pract. Off-label drug use in the treatment of polycystic ovary syndrome.
Fertil Steril. Metformin use in practice: compliance with guidelines for patients with diabetes and preserved renal function. Clin Diabetes. The clinical application of metformin in children and adolescents: A short update. Acta Biomed. Published Sep 7. Prescribers' Digital Reference. Metformin hydrochloride - Drug summary.
Metformin: a review of its potential indications. Drug Des Devel Ther. Published Aug Priya G, Kalra S. Metformin in the management of diabetes during pregnancy and lactation. The symptoms of PCOS vary person-to-person, which can make it challenging to identify. Many women suffer in silence, living undiagnosed for years.
Non-profit organizations throughout the U. It affects all metabolic functions as well as all aspects of the menstrual cycle and fertility. There are a variety of reasons why a woman of reproductive age might develop PCOS, but research shows that genetics, insulin resistance, and androgen excess also known as male hormones are all likely risk factors.
PCOS impacts women from a diverse range of backgrounds. While there is no cure for PCOS, there are ways to manage symptoms. Killoran says that there are a few medications that may be prescribed for PCOS patients, depending on how the condition affects them. This is not a complete list, but it includes:. Killoran adds. Metformin is a common medication used to treat PCOS symptoms. Laurence Gerlis , a general practitioner in London, England.
Gerlis says metformin for PCOS, when taken regularly, will lower blood glucose levels by balancing insulin levels and decreasing other metabolic effects of the condition. There are very few safety issues related to regular use of metformin, other than the loosening of bowels, Dr.
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