Metformin is an insulin sensitizer drug that has been used for type 2 diabetes for years and is now being used for polycystic ovarian syndrome treatment.
Polycystic ovarian syndrome (also called PCOS), is a common endocrine disorder affecting about 5-10% of women and adolescent girls.
It is characterized by hyperandrogenism (raised male hormones) giving women the unwanted clinical features of
- Hirsutism (increased hair on face and body),
- menstrual irregularity,
- and infrequent ovulation leading to infertility.
Because of the above-unwanted features, many women seek help from their family doctor and on the Internet, searching for polycystic ovarian syndrome treatment, looking for a solution to their problem.
So why is Metformin now considered a medication for polycystic ovarian syndrome treatment?
It has now been recognized by doctors and scientists, that increased secretion of the hormone Insulin from the pancreas – called hyperinsulinaemia and insulin resistance, is the central feature of the metabolic disorder of PCOS
The hormone Insulin regulates the sugar/ glucose levels in our blood stream and helps to store energy as fat…
… So you could say that insulin is a powerful fat building hormone.
Insulin resistance is a condition in which the body does not efficiently use insulin, so the pancreas has to make and secrete a lot more insulin to keep regulating and normalizing the blood glucose.
‘Polycystic ovarian syndrome women’ who have been diagnosed with insulin resistance, have higher blood insulin levels and higher glucose levels and are at greater risk of developing diabetes.
Obese women with polycystic ovarian syndrome have an added burden of insulin resistance related to their adiposity
In PCOS the elevated blood insulin levels is thought to stimulate a higher than normal secretion of Androgens (male hormones) from the ovary.
These elevated insulin levels and increased secreted male hormones can lead to many of the unwanted effects seen in polycystic ovarian syndrome, such as…
… the acne, hirsutism, infrequent menstrual cycles and potentially impair the egg and follicle development within the ovary – thereby affecting the quality of the egg.
If there is a poorer quality of egg, then it is less likely to fertilize and make a healthy embryo to implant in the uterus.
These elevated hormones could sometimes stop the growth and ovulation (release) of the egg… making it more difficult for women to achieve a pregnancy.
So to summarise above; the Insulin resistance and its role in the biology of PCOS is the reason Metformin is now prescribed for polycystic ovarian syndrome treatment.
What is Metformin?
Metformin is a biguanide agent and is the most widely used drug for the treatment of type 2 diabetes worldwide. It acts by lowering blood glucose levels by reducing the liver glucose production and increasing glucose utilization in the tissues.
A number of studies have now been published on polycystic ovarian treatment with Metformin use, showing…
- A reduction in insulin levels and insulin resistance – so it improves insulin sensitivity
- A decrease in the risk for progression to type 2 diabetes
- Improvement in hormone levels and menstrual cycle regularity, and fertility
- A reduction in hirsutism by reducing the raised insulin levels and reducing the raised male hormones called androgens
- An improvement in ovulation rate of 46% with Metformin, when compared with 24% of those women receiving placebo only. So Although metformin can be used to help ovulation induction, Clomiphene citrate is still the first line treatment to help induce ovulation
- A 4 fold decrease in miscarriage rates. But how long Metformin treatment should be continued in pregnancy is controversial and at present current guidelines are that it should be stopped after a positive pregnancy test result until more consistent data is available
How To Check If You Have Insulin Resistance
A visit to the family doctor is the first step. He or she will take some notes. To check for insulin resistance requires a fasting blood test for glucose tolerance and insulin levels. They may also want to check for other tests including cholesterol and lipids
What Are The Side Effects To Metformin?
There can be mild side effects such as gastrointestinal symptoms like nausea, a metallic taste in the mouth, increased bowel movement frequency. To minimise these potential side effects it is recommended to start Metformin treatment with a low dose at meal times and increase gradually to 1.5g/day.
A more serious but rare complication of Metformin is lactic acidosis. However this is related to chronic co-existent illnesses, which are contradictions of Metformin therapy use.