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How Does Metformin Help PCOS?

Women with polycystic ovary syndrome (PCOS) may be given metformin to reduce insulin resistance and the production of androgens (male hormones). This can improve the function of the ovary and re-establish regular periods.

Metformin can also be prescribed to PCOS patients at potential risk for prediabetes, type-2 diabetes and gestational diabetes mellitus or GDM, a condition in which a hormone made by the placenta prevents the body from using insulin effectively. In the case of pregnant women, it may also help avoid a miscarriage.

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What Is Metformin Used For?

Metformin is generally used to treat high blood sugar levels caused by type-2 diabetes. This is a type of diabetes in which the insulin produced by the pancreas fails to help the cells of the body get the required sugar, thus preventing the body from receiving the sugar needed to carry out body functions.

This drug helps lower the amount of glucose absorbed from the intestines and decreases the amount of glucose made in the liver. It also helps improve insulin sensitivity.

Metformin is also used to help reduce the risk of heart disease which is a major potential complication in diabetic patients.

Generic Name & Class

Metformin is a biguanide class of antihyperglycemic agents that act primarily by decreasing endogenous hepatic output of glucose by inhibition of gluconeogenesis.

How It Works

Metformin typically works by helping the body restore its insulin response. It decreases the amount of blood sugar that is absorbed in the intestines and stomach and also lowers the amount of blood sugar produced by the liver.

How Is It Dispensed?

Metformin can be dispensed in three ways — tablets, liquid and extended-release tablets.

  • Tablet — The regular tablet form of metformin is usually taken two or three times a day with meals.
  • Liquid — Doctors generally prescribe taking the liquid once or twice a day, depending on your condition.
  • Extended-release tablets — Also known as long-acting tablets, these are usually taken once a day, mostly prescribed with the evening meal. These are supposed to be swallowed whole and not crushed or chewed.

Regardless of the form of metformin prescribed to you, it is advisable to take your dosage at the same time every day.

Is This Prescription Effective for PCOS?

Specifically for women with PCOS, metformin helps in enhancing the body’s response to insulin, thus decreasing the circulating levels of insulin while also affecting the adipose (fat) tissues positively.

Traditionally metformin is prescribed to PCOS women with a raised Body Mass Index or BMI. However, recent studies show that this drug can also be quite helpful for women with lower BMIs. Non-obese women with anovulatory PCOS may also be prescribed metformin as an ovulation induction treatment. Moreover, studies suggest that the addition of this drug to the ovarian stimulation regime in In-Vitro Fertilisation (IVF) can also improve pregnancy outcomes.

It also produces several other positive effects in PCOS women like helping in weight loss, reducing the risk of diabetes and reducing androgens (male hormones) in the body. This also helps in relieving hyperandrogenic symptoms like hirsutism and acne.

What Are the Benefits?

Metformin helps improve insulin resistivity in PCOS patients, which is the root cause of PCOS for 70% of patients. It decreases the absorption of glucose from the stomach and the intestine and also prevents the liver from making excess insulin. All of this helps in reducing the levels of androgens in the body which thus helps get relief from hyperandrogenic symptoms like facial hair, hair loss and thinning of scalp hair, acne and more.

Therefore, metformin promotes hormonal balance, helps in weight loss and also improves metabolic health. Pregnant women with PCOS can benefit greatly as it reduces the risk of preterm delivery and gestational diabetes.

For women with anovulatory PCOS, this medication can help stimulate the ovaries to produce eggs and thus, regulate the menstrual cycle.

How Much Does Metformin Cost?

10 tablets of 500 mg of metformin can cost anything between INR 16 to INR 20, depending on the brand of tablets prescribed.

A 1000 mg strip can cost between INR 35 to INR 40.

The price of the drug depends on the brand and dosage prescribed. However, it is quite affordable but can be bought only with a prescription from a certified medical practitioner.

Understanding Your Dosage

Your dosage of metformin depends on your condition and various factors like:

  • The type and severity of your symptoms and your condition
  • Your age
  • Other underlying medical conditions

Initially, your doctor will start with a low dosage and adjust your medication with time, giving your body time to adjust.

You may be prescribed metformin in the form of tablets, liquid or extended-release tablets and further changes may be made depending on your body’s response.

500 mg vs. 1000 mg Dose

While the function of metformin remains the same, it is available in different strengths. Thus, the basic difference between metformin 500 mg and metformin 1000 mg is just its strength.

Doctors generally begin with a low dosage but if patients experience a sudden spike in their blood sugar levels, higher doses might be prescribed. Patients who are not benefiting from metformin 500 mg may be asked to start taking metformin 1000 mg to help control their blood sugar.

The strength of the drug required for your body can only be determined after analysing your symptoms and your condition. Please speak to your primary healthcare provider before opting for any medication.

How It Relates To Insulin Resistance

The body requires insulin to help the cells and organs absorb glucose from the blood. Insulin resistance is a condition in which the body doesn’t respond well to insulin, thus resulting in high blood sugar levels which can lead to serious conditions like PCOS and diabetes. This chaos also increases the amounts of circulating insulin in the body, causing the body to produce more androgens which cause many PCOS symptoms.

The primary function of metformin is to decrease the absorption of sugar by the intestines and stomach while preventing the liver from producing blood glucose. It also helps improve the body’s sensitivity to insulin and brings down the levels of insulin in the body.

Possible Side Effects in Women

Metformin is one of the most popular and reliable off-label drugs for PCOS. It also comes with certain side effects which you may or may not experience. Doctors generally start with a low dosage and give your body time to adjust.

The common side effects include:

  • Nausea
  • Bloating
  • Loss of appetite
  • Stomach ache
  • Diarrhoea

It is important to note that these symptoms are usually mild and their intensity varies from person to person depending on how well your body accepts the drug. Metformin is best taken with food to avoid feeling sick. In case you experience diarrhoea, make sure you keep yourself well hydrated and speak to your doctor who may alter your dosage or give you medicines to manage the side effects.

There is a very low risk of developing lactic acidosis, a condition in which lactic acid builds up in the bloodstream. This can happen in patients with kidney problems and in such cases of exceptions, doctors avoid prescribing metformin altogether.

Possible Drug Interactions

Metformin when combined with insulin can cause hypoglycaemia, a condition in which the blood sugar levels are lower than normal. However, people with type-2 diabetes might need metformin and insulin together, and they are not likely to develop hypoglycaemia.

Sulfonylureas and meglitinides are two groups of diabetes medications that cause the body to produce more insulin. However, when taken with metformin, there is a risk of the blood sugar levels dropping too low.

Carbonic anhydrase inhibitors are another group of medications used to treat various health conditions including seizures. These medicines may interact with metformin and raise your chances of developing lactic acidosis. Certain medications like Ranexa, Caprelsa, Tagamet HB and Tivicay prevent the body from getting rid of metformin, thus increasing your risk of lactic acidosis.

Alcohol also reacts with metformin, again putting you at a high risk of lactic acidosis.

Foods To Avoid

Avoid any foods that can spike your blood sugar levels.

Sugary foods and drinks, processed carbs, fried food and other such kinds of food will not directly worsen your condition but will make it much harder for the metformin to work, thus prolonging your symptoms.

Frequently Asked Questions

A lot of questions surround metformin as it is an off-label drug used for PCOS treatment. Here are some very common questions you might have

Does Metformin cause hair loss?

No, metformin is an insulin sensitizer whose primary function is to improve the functioning of insulin and regulate blood sugar levels - it does not cause hair loss. However, the conditions that metformin is used to treat such as PCOS and type 2 diabetes can cause scalp hair loss.

Does Metformin cause weight loss?

Metformin directly will not cause you to lose weight, but considering the conditions it works upon, like lowering blood sugar levels and increasing insulin responsiveness in the body, patients may increase a slight reduction in their weight.

Does Metformin lower blood sugar?

Yes, one of the main functions of this medication is to reduce the amount of blood sugar absorbed by the intestines and stomach. It also prevents the liver from producing more blood sugar. Thus, metformin greatly helps lower blood sugar and is also prescribed to diabetic patients.

Is it safe?

The benefits of metformin often outweigh the side effects. It may help you manage the symptoms of PCOS by reducing insulin resistance and can also help avoid complications associated with type 2 diabetes. ⁣Metformin’s side effects are well understood and are often not a cause of concern. Usually, when you are prescribed this medication, your doctor will start with a low dosage and build the dosage over time to avoid stomach issues.