What Is Metformin?

What is metformin and how could it help with my PCOS? What do I need to know before taking it?
profile picture of Mark P. Leondires, MD, medical director and lead infertility doctor with Reproductive Medicine Associates of Connecticut
ByMark P. Leondires, MD, medical director and lead infertility doctor with Reproductive Medicine Associates of Connecticut
Fertility Specialist
Updated
Mar 2017
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Metformin is a medication that seems to help the muscles use insulin better and may help lower insulin levels. Metformin is actually a medication for diabetics; some diabetics take it as a first line of defense, in hopes of avoiding having to take insulin. But because some women with  PCOS (polycystic ovarian syndrome) meet criteria for diabetes risk, it could be prescribed for them, too.

There are a variety of different types of cases of PCOS, but many women with the syndrome have a metabolic disorder associated with  irregular menstrual cycles and/or hyperandrogenism (a hormone imbalance) and/or problems with insulin resistance, pre-diabetes or diabetes. PCOS can make it more difficult to get pregnant.

Probably the most powerful tools for helping with PCOS are exercise and a healthy diet. You really can improve your fertility by taking charge of your own health and making good lifestyle decisions. If diet and exercise don’t help, your doctor may prescribe metformin.

Because of the mix of symptoms associated with PCOS, it’s hard to say whether high insulin levels cause the hormone imbalance or vice versa, but the idea with metformin is that lower insulin levels can help get hormone levels back to where they should be, causing ovulation. If you’re ovulating, you’re more likely to get pregnant.

Metformin is taken orally with food, so there’s a chance of gastrointestinal issues, like flatulence and upset stomach. Doctors recommend patients take it “to tolerance,” meaning you may start out taking one pill per day and then gradually increase to three to four pills per day.

Before deciding to prescribe you metformin, your doctor will give you a glucose tolerance test to see how your body is processing sugars. She’ll also check your liver enzymes and do a blood test to make sure you’re not anemic, to be sure you can properly metabolize the medication.

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A lot of women who start on metformin end up taking it for life, unless they change their lifestyle and/or lose weight. But some ob-gyns take their patients off of it during  pregnancy and opt to give them injectable insulin instead. While metformin is usually considered safe during pregnancy, there are differing opinions on whether or not to give it to pregnant patients, so once you do become pregnant, check with your doctor to see what she recommends.

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