Polycystic Ovarian Syndrome (PCOS) is a common cause of infertility. Patients with PCOS often have insulin resistance, which means that your pancreas is producing a large amount of insulin to maintain a normal glucose level. This is called hyperinsulinemia. Hyperinsulinemia leads to increased levels of androgens in the ovaries. This may directly interfere with ovulation. Metformin is an oral antihyperglycemic agent and has been shown to improve the body’s use of insulin, therefore, decreasing androgen levels and restoring normal ovulatory function.

PRIOR TO TREATMENT:

You will need the following labs before starting metformin:

• FASTING BLOOD SUGAR
• INSULIN LEVEL
• BUN, CREATININE
• DHEAS, TESTOSTERONE, 17-OHP

DURING TREATMENT:

It is very important to maintain a proper diet. Weight loss has been demonstrated to decrease androgen levels as well as achieve increased insulin sensitivity. A daily exercise routine is essential to your health, especially during therapy.

Avoid excessive alcohol intake while taking metformin. Alcohol increases your risk of lactic acidosis. Lactic acidosis is caused by a build-up of lactic acid in the blood. This condition is rare and occurs mostly in people whose kidneys are not working normally.

HOW TO TAKE METFORMIN:

Metformin comes in 500-mg tablets and is started at once daily for one week, then increased to twice daily for the second week, and then finally three times daily. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not “double up”.

SIDE EFFECTS:

Common side effects are nausea, vomiting, diarrhea, loss of appetite, stomach fullness, constipation, and heartburn.

GOAL OF THERAPY:

To decrease insulin resistance and androgen levels, establishing the return of normal ovulatory cycles and decreasing the long-term health problems, as well as to eradicate unwanted hirsutism (hair growth), acne, and obesity.

PREGNANCY:

Discontinue metformin with positive pregnancy test. Metformin is pregnancy category “B” indicating that there are no apparent fetal risks based on animal reproductive studies nor any risks associated with use of the drug during the late trimesters of pregnancy. If you are a known diabetic, your obstetrician may continue the drug or switch you over to insulin.

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