Abnormal Bleeding After Metformin for PCOS Management

After taking Metformin for polycystic ovary syndrome (PCOS), there was bleeding?

Hello, doctor.
I would like to ask a question.
I previously consulted two obstetricians who both indicated that I have polycystic ovary syndrome (PCOS), as the ultrasound showed multiple small follicles in my ovaries.
Blood tests also revealed that my androgen levels are two to three times higher than normal.
Currently, I am 155 cm tall and weigh 60 kg.
My menstrual cycle is irregular; for instance, my period came on February 1st, and from February 2nd to February 4th, the flow was very heavy with large blood clots.
I have been experiencing dizziness daily.
On February 10th, since my period had not ended after ten days, the doctor initially prescribed medication to stop the bleeding.
During a follow-up on February 17th, the doctor stated that my liver and kidney functions were normal, and my iron levels were also normal, indicating no possibility of anemia.
I was later diagnosed with PCOS and prescribed Metformin, with instructions to take it for a month before returning for a follow-up.
However, after just one day of taking it, I experienced bleeding (brown in color, but still enough to require a panty liner), even though my period had just ended.
Recently, I have been under a bit of stress, and sometimes I return home around 10 or 11 PM, with my bedtime around midnight.
However, if time permits, I try to go to bed by 11 PM.
Is this normal? Is there anything I should be aware of?

hui, 30~39 year old female. Ask Date: 2021/02/18

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the factors that can affect the menstrual cycle or cause bleeding outside of menstruation are numerous, including age, environment, lifestyle, stress, emotional instability, and polycystic ovary syndrome, among others.
If the bleeding persists, it is advisable to consult a gynecologist for an examination to determine if there is a hormonal imbalance or other underlying causes that require treatment.
Thank you! Wishing you peace and health.
Dr.
Chang

Reply Date: 2021/02/18

More Info

Abnormal bleeding after starting Metformin, particularly in the context of Polycystic Ovary Syndrome (PCOS), can be concerning and warrants careful consideration. PCOS is a common endocrine disorder characterized by hormonal imbalances, which can lead to irregular menstrual cycles, excessive androgen levels, and various other symptoms. The introduction of Metformin, a medication primarily used to manage insulin resistance and improve ovulatory function in women with PCOS, can sometimes lead to unexpected side effects, including changes in menstrual bleeding patterns.

In your case, it appears that you have been experiencing heavy menstrual bleeding with large blood clots, followed by the onset of abnormal bleeding after starting Metformin. This situation can be influenced by several factors:
1. Hormonal Fluctuations: PCOS is associated with hormonal imbalances, particularly elevated levels of androgens (male hormones). The introduction of Metformin can help regulate insulin levels and may indirectly influence hormonal balance, potentially leading to changes in your menstrual cycle. It’s not uncommon for women with PCOS to experience irregular bleeding when starting a new medication.

2. Stress and Lifestyle Factors: You mentioned experiencing increased stress and irregular sleep patterns. Stress can significantly impact hormonal regulation and menstrual cycles. Lack of sleep and high-stress levels can exacerbate hormonal imbalances, leading to further irregularities in your menstrual cycle.

3. Metformin Side Effects: While Metformin is generally well-tolerated, some individuals may experience gastrointestinal side effects, which can include nausea, diarrhea, and abdominal discomfort. These side effects can sometimes lead to changes in appetite and overall health, which may indirectly affect menstrual cycles.

4. Underlying Conditions: It’s essential to consider that other underlying conditions could contribute to abnormal bleeding. Conditions such as uterine fibroids, endometrial hyperplasia, or other gynecological issues may also play a role. Regular follow-ups with your healthcare provider are crucial to rule out these possibilities.

Given your situation, it is advisable to monitor the bleeding closely. If the abnormal bleeding persists or worsens, it is essential to consult your healthcare provider. They may recommend further evaluation, such as blood tests to check hormone levels, an ultrasound to assess the ovaries and uterus, or other diagnostic procedures to ensure there are no underlying issues that need to be addressed.

In terms of lifestyle modifications, managing stress through relaxation techniques, regular exercise, and maintaining a healthy diet can be beneficial. Additionally, establishing a consistent sleep schedule can help improve overall hormonal balance and menstrual regularity.

In summary, while some degree of irregular bleeding may occur after starting Metformin, especially in the context of PCOS, it is essential to remain vigilant and communicate any concerns with your healthcare provider. They can provide personalized guidance and adjust your treatment plan as necessary to ensure your health and well-being.

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