What is Metformin?
Metformin, or Glucophage, is a medical drug created with an original intention to balance blood sugars in Type 2 Diabetics who experience evaluated blood glucose levels. Another way Metformin is now commonly used to is to treat women with Polycystic Ovarian Syndrome (PCOS).
What is PCOS?
Polycystic Ovarian Syndrome, or PCOS, is a condition that influences hormone levels in women. Women who experience PCOS produce male hormones at a higher than average level leading to a hormone imbalance. PCOS affects the ovaries, the female reproductive organs responsible for producing estrogen and progesterone, which regulate a woman’s menstrual cycle. A small amount of androgens (male hormones) are also produced by the ovaries. As you likely know, the ovaries are also responsible for releasing an egg each month during ovulation.
PCOS effects women in their childbearing years (ages 15–44) and is experienced by anywhere between 2.2 and 26.7 percent of women in this age bracket. The reason this range is so wide is that most women with PCOS do not know they have it—up to 70% one study found.
How does PCOS effect the body? What are the symptoms?
PCOS is a syndrome, which indicates a collection of symptoms. In the case of PCOS, these symptoms are: ovarian cysts, high male hormone levels and skipped or irregular menstrual cycles.
Polycystic means “many cysts.” With PCOS, small, fluid-filled sacs, called cysts, grow inside the ovaries. Each sac is a follicle that contains one immature egg that will not mature enough to trigger ovulation. Without ovulation, hormone levels of estrogen, progesterone, FSH and LH are lowered, while androgen levels grow higher than normal. The increase in male hormones disrupt the menstrual cycle, leading to irregular periods.
These symptoms may lead to difficulty getting pregnant, excess hair growth on the body or face or hair loss on the head. Long-term health issues like diabetes and heart disease can also be brought on by PCOS.
What causes PCOS?
The exact cause of PCOS is still unknown, but it is thought that the foundation of PCOS is elevated male hormones, which block the ovaries from producing female hormones and growing eggs normally. Three things have been linked to heightened androgen levels: genes, inflammation and insulin resistance.
Research has shown that PCOS runs in families and, therefore, may be genetically predisposed. However, it is hypothesized that many, not a single, gene contributes to a woman experiencing PCOS.
Women diagnosed with PCOS often exhibit increased inflammation in the body. Excess body weight can lead to inflammation. Research has also linked higher androgen levels to inflammation. In this case, it’s sometimes difficult to know what came first—the inflammation or the symptoms.
Insulin resistance occurs when the body is not able to utilize insulin to its full capability. Insulin is produce in the pancreas and responsible for core functions like regulating blood sugar and using sugars from food as energy. When cells are resistant to insulin, the body needs to create more of it. The increased insulin levels cause the ovaries to produce more male hormones to help with the process. Obesity is the number one cause of insulin resistance.
Treating PCOS with Metformin
Metformin is designed to increase insulin sensitivity. While it was originally prescribed to treat Type 2 Diabetics, it is not also prescribed as an “off label” drug to treat PCOS since insulin resistance is often a cause of the syndrome.
Metformin helps cells respond to insulin and, in turn, reduces the burden on the body to produce excess insulin to compensate. Reduced insulin production equals reduced male hormone production, which can alleviate symptoms of PCOS. To do this, the drug suppresses endogenous glucose production happening in the liver.
Two small studies have also shown Metformin to decrease the change of miscarriage and gestational diabetes in women with PCOS. Unlike other drugs used to treat PCOS, Metformin does not cause weight gain or fluid retention. It does not cause hypoglycemia or increase insulin secretion.
Side effects of Metformin
The side effects of Metformin are generally minimal and may include:
- Anemia cause by a decrease in Vitamin B12 absorption
- Gastrointestinal issues, such as nausea and vomiting, diarrhea, gas and bloating and abdominal pain
- Higher levels of amino acids in the blood, which may cause atherosclerosis
Other ways to treat PCOS
Birth control pills, patch and vaginal rings containing estrogen and progestin have been show to balance hormone levels and alleviate symptoms of PCOS.
Clomid is the most common fertility drug on the market. It can be used to treat PCOS but does increase the change of multiple births and can be harder on the body (more side effects) than other treatments.
Some women may decide to undergo surgery as a more method of treating PCOS if other treatments do not work. Through a procedure called ovarian drilling, tiny holes are made in the ovary using a laser-thin needle to stimulate normal ovulation.