Managing PCOS and Insulin Resistance: The Role of Metformin

Polycystic Ovary Syndrome (PCOS) & Metformin

About ten years ago, I was diagnosed with polycystic ovary syndrome (PCOS) through a vaginal ultrasound.
Most of the doctors I consulted over the past decade prescribed me medications such as hormonal pills, ovulation induction drugs, and contraceptives.
However, whenever I stopped taking these medications, my menstrual cycle would cease, and I even experienced nausea.
I am reluctant to become dependent on these medications and have avoided taking them for six months, resulting in the absence of menstruation.
Eventually, I resorted to taking menstrual induction medication.

I have a regular exercise routine and avoid processed foods, opting to eat whole foods as much as possible.
However, my weight loss has been significantly slower than average.
While others may lose 5-6 kg, I have only lost 1 kg.
Occasionally, I face fluctuations in weight, where I might gain 1-1.5 kg overnight.
Blood tests confirmed that I have insulin resistance with a level of 23.8, and my fasting blood glucose is within the normal range at 87.

The doctor is unwilling to prescribe metformin, stating that since my blood sugar is normal, taking it could lead to dangerously low blood sugar levels.
However, from what I understand, metformin does not typically cause hypoglycemia in individuals with normal blood sugar levels.
In the past, another doctor had prescribed metformin to me, but I did not continue taking it because I was young and did not understand its purpose, thinking that since my blood sugar was fine, there was no need for a medication that lowers blood sugar.
I have read many articles related to PCOS, insulin resistance, and metformin, and I am aware that individuals with a family history of diabetes have a higher likelihood of developing insulin resistance.
My grandmother has diabetes, and several of my aunts and uncles also have diabetes due to hereditary factors.
The doctor who refuses to prescribe metformin has advised me to manage my weight and continue monitoring my condition.

Could my symptoms be better managed with metformin?

Michelle, 30~39 year old female. Ask Date: 2015/07/14

Dr. Lin Manying reply Obstetrics and Gynecology

Combination with metformin may be attempted, but blood glucose levels must be monitored.

Reply Date: 2015/07/14

More Info

Managing Polycystic Ovary Syndrome (PCOS) and insulin resistance can be quite challenging, especially when conventional treatments do not seem to provide relief or improvement. Your situation highlights several important aspects of PCOS, insulin resistance, and the potential role of Metformin in treatment.

PCOS is a complex endocrine disorder that affects many women of reproductive age. It is characterized by a combination of symptoms, including irregular menstrual cycles, excess androgen levels, and polycystic ovaries. One of the common underlying issues in PCOS is insulin resistance, which can lead to weight gain, difficulty losing weight, and an increased risk of developing type 2 diabetes.

Metformin is an oral medication primarily used to treat type 2 diabetes, but it has also been found to be beneficial for women with PCOS, particularly those who are insulin resistant. The medication works by improving insulin sensitivity, which can help lower insulin levels in the body. This, in turn, can lead to a reduction in androgen levels, potentially improving menstrual regularity and ovulation. Additionally, Metformin may assist with weight management, which is often a significant concern for women with PCOS.

Your concerns about Metformin are valid, especially considering your history of gastrointestinal discomfort and skin allergies. While Metformin can cause gastrointestinal side effects such as nausea, diarrhea, and abdominal discomfort, many patients find that these side effects diminish over time or can be managed by starting with a lower dose and gradually increasing it. It is essential to discuss these concerns with your healthcare provider, who can help determine whether the benefits of Metformin outweigh the potential risks in your specific case.

Regarding your doctor's hesitance to prescribe Metformin due to your normal fasting blood sugar levels, it is important to note that Metformin is not solely prescribed based on blood sugar levels. Its efficacy in managing insulin resistance and improving symptoms of PCOS has been well-documented, even in patients with normal glucose levels. Your family history of diabetes and your current insulin resistance (as indicated by your insulin level of 23.8) further support the consideration of Metformin as a treatment option.

In terms of managing your symptoms, lifestyle modifications such as maintaining a healthy diet and regular exercise are crucial. However, as you have experienced, weight loss can be particularly challenging for women with PCOS and insulin resistance. Metformin may provide additional support in this area by helping to regulate insulin levels and potentially aiding in weight loss efforts.

If you are considering Metformin, it would be beneficial to have a candid discussion with your healthcare provider about your concerns, the potential benefits of the medication, and any alternative options that may be available. If your current provider is unwilling to prescribe Metformin, you might consider seeking a second opinion from an endocrinologist or a reproductive endocrinologist who specializes in PCOS and insulin resistance.

In summary, Metformin can be an effective treatment option for managing PCOS and insulin resistance, even in patients with normal blood sugar levels. It is essential to weigh the potential benefits against any side effects and to work closely with a healthcare provider who understands your unique situation. With the right approach, you may find that Metformin helps improve your symptoms and overall quality of life.

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