Metformin For Pcos Symptoms: 5 Challenging Cases
Metformin for PCOS symptoms: 5 challenging cases Dr. Barbieri is chief of the department of obstetrics and gynecology at Brigham and Womens Hospital in Boston, Mass, and Kate Macy Ladd Professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School. He is editor-in-chief of OBG Management. This inexpensive and versatile drug broadens the choices for treating polycystic ovary syndrome. An expert describes its efficacy for common manifestations of PCOS. 1. Barbieri RL. Metformin for the treatment of the polycystic ovary syndrome. Obstet Gynecol. 2003;101:785-793. 2. Pugeat M, Ducluzeau PH. Insulin resistance, polycystic ovary syndrome and metformin. Drugs. 1999;58 (suppl 1):41-46. 3. Kirpichnikov D, McFarlane SI, Sowers JR. Metformin: an update. Ann Intern Med. 2002;137:25-33. 4. Knochenhauer ES, Key TJ, Kahsar-Miller M, et al. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998;83:3078-3082. 5. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, et al. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab. 1999;84:4006-4011. 6. Asuncion M, Calvo RM, San Millan JL, et al. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab. 2000;85:2434-2438. 7. Arroyo A, Laughlin GA, Morales AJ, et al. Inappropriate gonadotropin secretion in polycystic ovary syndrome: influence of adiposity. J Clin Endocrinol Metab. 1997;82:3728-3733. 8. Taylor AE, McCourt B, Martin KA, et al. Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Continue reading >>
Polycystic Ovary Syndrome And Pregnancy: Is Metformin The Magic Bullet?
This article reviews the literature regarding the effects of metformin therapy in pregnant women with polycystic ovary syndrome on weight loss, fertility, early pregnancy loss, malformations, gestational diabetes mellitus, perinatal mortality, placental clearance, lactation, and early childhood development. The pharmacology of metformin is also presented. Preliminary data suggest that metformin for this population may be both safe and effective. Large blinded, randomized clinical trials are underway to confirm the preliminary safety data. History of Polycystic Ovary Syndrome Although the first description of polycystic ovary syndrome (PCOS) is generally credited to Stein and Leventhal in 1935, it may have been observed as early as 1721, when the Italian scientist Antonio Vallisneri observed “young married peasant women, moderately obese and infertile, with two larger than normal ovaries, bumpy and shiny, whitish, just like pigeon eggs.”1 This depiction sounds strikingly similar to the subfertility and obesity commonly found in PCOS. It was not until 1921 that Achard and Theirs2 noticed a relationship between hyperandrogenism and insulin resistance in their study of the “bearded diabetic woman.” And in 1935, Stein and Leventhal3 made the connection between amenorrhea and polycystic ovaries. In addition, they also noticed the occurrence of masculinizing changes, such as hirsutism and acne, in many patients with polycystic ovaries. Several, but not all, of Stein and Leventhal's original case studies involved women who were overweight. In all seven of their case reports, attempts to treat ovulatory dysfunction with estrogenic hormone failed, and wedge resection was employed. All of their patients gained normal menstruation, and two became pregnant. Surgery for PCOS Continue reading >>
Can Metformin Help Women With Pcos?
Home / Fertility / Boosting Fertility We asked doctors whether the drug Metformin really helps women with PCOS conceive, reduce miscarriage risk and increase milk supply. Here's what they say. If you have polycystic ovary syndrome (PCOS), you're not alone. According to the National Center for Biotechnology Information , this hormonal disorder affects between 5 percent and 15 percent of women of reproductive age in this country. In polycystic ovary syndrome, cysts develop on the ovaries, and the body produces excess hormones called androgens, which cause an irregular menstrual cycle. As a result, ovulation can be unpredictable, and getting pregnant can be challenging. "Since puberty, I've averaged one menstrual cycle per year," says Carrie, a mother from the Midwest who has PCOS. "I always wondered if I could have children." Carrie tried getting pregnant for several months, but wasn't able to because she wasn't ovulating. After evaluating her bloodwork, her OB/GYN suggested she go on either Clomid or Metformin to help balance her hormones to promote ovulation. "Because I had a very slight imbalance in my hormones, my doctor suggested trying Metformin before going straight to Clomid. Since I heard horror stories about Clomid causing multiples, I was happy to try Metformin first," Carrie says. Metformin is a diabetes medication that is sometimes used to regulate hormones in women with PCOS by balancing their insulin level. This effect leads to more regular menstruation and ovulation cycles , according to WebMD . Carrie got pregnant the first month she took Metformin. But not all women with polycystic ovary syndrome have such good results. In fact, experts say more evidence is needed to prove that Metformin helps conception in PCOS patients . "When putting all the data tog Continue reading >>
Metformin And Pcos: Everything You Need To Know
Metformin is a type of medication used to treat Type 2 Diabetes. Because there is a strong link between diabetes and PCOS, metformin is now commonly proscribed to treat PCOS. But should it be? What is the real relationship between metformin and PCOS? Can Metformin used for PCOS help lessen PCOS symptoms? Metformin used for PCOS: The Science PCOS is an infertility condition that often causes acne, facial hair growth, balding, low sex drive, weight gain, difficulty with weight loss, and mental health disturbances such as depression and anxiety in approximately 15% of women. It is also associated with a myriad of health conditions, spanning from diabetes to hypothyroidism and to heart disease. PCOS is, in short, not a condition to sneeze at. PCOS is a condition of hormone imbalance. With PCOS, male sex hormones such as testosterone and DHEA-S rise relative to the female sex hormones estrogen and progesterone. (…Roughly speaking – it’s complicated. For a full-blown account of the science of PCOS and how it affects you, see here.) Elevated testosterone is very often the primary culprit in causing PCOS. (But not always! For one of my most thorough accounts of other things that can cause PCOS, see here.) Insulin causes testosterone levels to rise because insulin tells the ovaries to produce testosterone. Basically, elevated insulin causes elevated testosterone, which causes PCOS. This is where metformin comes into play. Metformin lowers blood sugar levels below what they would otherwise be after a meal. This is because it intervenes with the liver’s interaction with and production of glucose. Insulin is the body’s way of dealing with blood sugar. If blood sugar is lower, then insulin will be lower, and thus testosterone will be lower. Metformin decreases blood sugar, Continue reading >>
Polycystic Ovary Syndrome - Treatment - Nhs
Polycystic ovary syndrome (PCOS) can't be cured, but the symptoms can be managed. Treatment options can vary because someone with PCOS may experience a range of symptoms, or just one. The main treatment options are discussed in more detail below. In overweight women, the symptoms and overall risk of developing long-term health problemsfrom PCOS can be greatly improved by losing excess weight. Weight loss of just 5% can lead to a significant improvement in PCOS. You can find out whether you're a healthy weight by calculating your body mass index (BMI) , which is a measurement of your weight in relation to your height. Anormal BMIis 18.5-24.9. Usethe BMI healthy weight calculator to work out whether your BMI is in the healthy range. You can lose weight by exercising regularly and having a healthy, balanced diet . Your diet should include plenty of fruit and vegetables, (at least five portions a day ),whole foods (such as wholemeal bread, wholegrain cereals and brown rice), lean meats, fish and chicken. Your GP may be able to refer you to a dietitian if you need specific dietary advice. Read more about losing weight , healthy eating and exercise . A number of medicationsare available to treat different symptoms associated withPCOS. These are described below. The contraceptive pill may be recommended to induce regular periods, or periods may be induced using anintermittent course of progestogen tablets (which are usually given every three to four months, but can be given monthly). This will also reduce the long-term risk of developing cancer of the womb lining (endometrial cancer) associated with not having regular periods. Other hormonal methods of contraception, such as an intrauterine (IUS) system , will also reduce this riskby keeping the womb lining thin, but they may Continue reading >>
Metformin For Treatment Of The Polycystic Ovary Syndrome
INTRODUCTION The polycystic ovary syndrome (PCOS) is characterized by both oligo/amenorrhea and androgen excess in women. When fully expressed, the manifestations include irregular menstrual cycles, hirsutism, obesity, and a constellation of cardiometabolic disturbances. It is a common endocrinopathy, occurring in 5 to 7 percent of reproductive age women [1-3]. The use of metformin in the management of PCOS will be reviewed here. The clinical manifestations, diagnosis, and other treatment options for PCOS are reviewed separately. (See "Clinical manifestations of polycystic ovary syndrome in adults" and "Diagnosis of polycystic ovary syndrome in adults" and "Treatment of polycystic ovary syndrome in adults".) OVERVIEW Interest in the use of metformin, an insulin-lowering drug, in PCOS increased when it was appreciated that insulin resistance played an important role in the pathophysiology of the disorder. Metformin is typically the first-line treatment for patients with type 2 diabetes; it is not approved for use in prediabetes or PCOS, although it is often prescribed for treatment of these conditions. Early trials in women with PCOS subsequently demonstrated a small benefit for weight reduction, a decrease in serum androgens (without improvement in hirsutism), and restoration of menstrual cycles in approximately 50 percent of women with oligomenorrhea (although not always ovulatory). Early data also suggested that metformin was effective for ovulation induction in anovulatory women with PCOS. As a result, metformin was used "off-label" for a number of these indications [4,5]. Although there was widespread enthusiasm for metformin therapy in women with PCOS for a number of years, clinical data do not support the use of metformin for treatment of hirsutism or as first-lin Continue reading >>
- Type 1 Diabetes and Polycystic Ovary Syndrome: Systematic Review and Meta-analysis
- Polycystic Ovary Syndrome and Diabetes
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
Long-term Metformin In Pcos Benefits Women Of All Weights
Long-term Metformin in PCOS Benefits Women of All Weights Metformin improves menstrual cycle regularity and lowers body mass index (BMI), testosterone, and luteinizing hormone (LH) within 6 months of treatment in women with polycystic ovary syndrome (PCOS) who are normal weight or overweight, new results show. The study is one of the few to examine the long-term effects of metformin, which was given daily for 2 years, although researchers found that most benefits emerged after 6 months, with over 40% of patients achieving normal menstruation by this point. The trial is also the first to evaluate metformin in all subgroups of women with PCOS, as most prior studies have looked at patients who are obese and/or hyperandrogenic (androgen excess), say the authors led by Po-Kai Yang, MD, from the National Taiwan University Hospital, Taipei City. The study was published online January 9 in the Journal of Clinical Endocrinology & Metabolism. They found that there are differences in treatment response to metformin between different BMI/testosterone subgroups of which there were four which could help in patient selection for treatment. For menstrual regularity the primary endpoint the normal weight, excess testosterone subgroup had the most significant sevenfold improvement from baseline, whereas the overweight, normal testosterone subgroup had the longest duration of improvement and the highest rate of normal menses after treatment (achieved by > 60% vs baseline). The reason for the difference in menstrual response between BMI/testosterone phenotypes is unknown, "but probably relates to the different pathophysiological mechanisms displayed over the spectrum of clinical manifestations in PCOS," the researchers say. New Look at Metformin Effects in All Women With PCOS The authors Continue reading >>
Role Of Metformin In The Management Of Polycystic Ovary Syndrome
Go to: Background Polycystic ovary syndrome (PCOS) is the most common endocrinological disorder affecting 4–12% of women [Diamanti-Kandarakis et al. 1999; Farah et al. 1999; Knochenhauer et al. 1998]. It has also been the most controversial medical condition and every aspect has received a lot of attention from the nomenclature to the management. Several descriptions of similar conditions took place in the 20th century and it was named Stein—Leventhal Syndrome in 1935 after the authors who described polycystic ovarian morphology in patients suffering from hirsutism, amenorrhoea and infertility [Leventhal, 1958; Stein and Leventhal, 1935]. PCOS was also called polycystic ‘ovarian’ syndrome implying that the primary pathology lies in or triggered by the ovary. Others have called it polycystic ovary disease (PCOD), which is the least used term for obvious reasons. Currently, PCOS refers to a disorder with a combination of reproductive and metabolic characteristics. This has evolved over time with controversy over the definition culminating in the latest consensus [ESHRE/ASRM, 2004] which instead of solving the issue created more controversy [Azziz et al. 2006]. In the European Society of Human Reproduction and Embryology/American Society of Reproductive Medicine (ESHRE/ASRM) consensus, at least two of the following features are needed to make the diagnosis; oligo/anovulation, hyperandrogenism, and polycystic features on ultrasound scan [ESHRE/ASRM, 2004]. The Androgen Excess Society, however, recommended that androgen excess should remain a constant feature of PCOS irrespective of the ovulatory status and morphological features of the ovaries [Azziz et al. 2006]. For almost three decades, PCOS has been regarded as a life course disease which besides its reproductiv Continue reading >>
Pcos Treatments
If a woman is not seeking to become pregnant, hormonal birth control (most often birth control pills) is a standard treatment. Birth control pills regulate periods and improve excess hair growth and acne by lowering androgen levels and protect the endometrium (inner lining of the uterus) against abnormal cell growth. Older types of birth control pills have lower risk for dangerous blood clots and are preferable over new types of birth control pills. Although metformin is not approved by the FDA for treatment of PCOS, many doctors prescribe it for PCOS patients. Metformin is a medicine that makes the body more sensitive to insulin. This can help lower elevated blood glucose levels, insulin levels, and androgen levels. People who use metformin may lose some weight as well. Metformin can improve menstrual patterns, but metformin doesn’t help as much for unwanted excess hair. Many women who are diagnosed with PCOS are often automatically prescribed metformin. However, it's important to have a reason for taking metformin and not be on it just because of a diagnosis of PCOS. Discuss with your doctor the reason why you are taking metformin and whether it is providing a benefit to you. Clomiphene (Clomid) is an oral medication that is the most common treatment used to induce ovulation. The use of both metformin and clomiphene has about the same fertility results as clomiphene use alone. A benefit is that metformin may help reduce the risk for ovarian hyperstimulation syndrome (see also "What is ovarian hyperstimulation syndrome (OHSS) during assisted reproductive technology (ART) fertility treatments. Other treatments to stimulate ovulation include another oral medication called letrozole (Femara) and gonadotropins which are hormones that are given by injection. In vitro fert Continue reading >>
Metformin And Pcos Health Benefits Or Side Effects
Metformin and PCOS Health Benefits or Side Effects If you have Polycystic Ovary Syndrome ( PCOS ) and have been prescribed metformin, chances are you have a lot of questions and concerns about taking this medication. The majority of women with PCOS have high insulin levels which cause weight gain, cravings, and even dark patches on your skin. Over time, exposure to high insulin levels can make you insulin resistant or turn into type 2 diabetes . Metformin works to lower your insulin and reduce your risk for diabetes. This article will show you what you need to know about taking metformin if you have PCOS. Metformin is one of the oldest andmost studied drugs available in the United States. Other names for metformin include Glucophage, Glucophage XR, glumetza, and fortamet. Although its not labeled for use in women with PCOS, metformin is one of the most common medications used to manage the condition. Metformin has been studied in girls as young as 8 years of age, with some researchers recommending it to prevent the onset of PCOS. Metformin works as an insulin-sensitizer to reduce your production of glucose. Metformin lowers blood glucose and insulin levels in three ways: 1. It suppresses the liver's production of glucose. 2. It increases the sensitivity of your liver, muscle, fat, and cells to the insulin your body makes. 3. It decreases the absorption of carbohydrates you consume. The average dose of metformin for women with PCOS is 1,500 mg to 2,000 mg daily. Besides lowering your glucose and insulin levels, metformin may provide other health benefits to women with PCOS. Metformin can enhance ovulation and regulate menstrual cycles. This means if you are sexually active, you should use birth control to prevent pregnancy, even if you havent been getting your period re Continue reading >>
Pcos Weight Gain Causes And Treatments
Many of these conditions can lead to heart disease . In fact, women with PCOS are four to seven times more likely to have a heart attack than women of the same age without the condition. Experts think weight gain also helps trigger PCOS symptoms, such as menstrual abnormalities and acne . What can I do to lose weight if I have polycystic ovary syndrome? Losing weight not only cuts your risk for many diseases, it can also make you feel better.When you have PCOS, shedding just 10% of your body weight can bring your periods back to normal. It can also help relieve some of the symptoms of polycystic ovary syndrome. Weight loss can improve insulin sensitivity. That will reduce your risk of diabetes , heart disease, and other PCOS complications. To lose weight, start with a visit to your doctor. The doctor will weigh you and check your waist size and body mass index. Body mass index is also called BMI, and it is the ratio of your height to your weight. Your doctor may also prescribe medication. Several medications are approved for PCOS, including birth control pills and anti-androgen medications. The anti-androgen medications block the effects of male hormones. A few medications are used specifically to promote weight loss in women with PCOS. These include: Metformin ( Glucophage ). Metformin is a diabetes drug that helps the body use insulin more efficiently. It also reduces testosterone production. Some research has found that it can help obese women with PCOS lose weight. Thiazolidinediones. These should be used with contraception . The drugs pioglitazone ( Actos ) and rosiglitazone ( Avandia ) also help the body use insulin. In studies, these drugs improved insulin resistance. But their effect on body weight is unclear. All patients using Avandia must review and fully un Continue reading >>
Metformin For Pcos And Getting Pregnant
Metformin and other insulin-sensitizing medications lower excess levels of insulin in the body.Besides metformin, rosiglitazone and pioglitazone are other insulin-sensitizing drugs that may be used to treat PCOS. There are several reasons why your doctor may prescribe metformin when treating your PCOS, some of them fertility related: As stated above, insulin resistance is common in women with PCOS. Metformin may be prescribed to treat insulin resistance, which may then help regulate the reproductive hormones and restart ovulation. Some research on metformin and PCOS shows that menstrual cycles become more regular and ovulation returns with the treatment of metformin. This may happen without needing fertility drugs like Clomid . However, some larger research studies did not find a benefit to taking metformin. For this reason, some doctors are recommending that metformin be used only to treat women who are insulin-resistant and not all women with PCOS regardless of whether or not they are insulin-resistant. While Clomid will help many women with PCOS ovulate, some women are Clomid-resistant . (This is a fancy way of saying that it doesn't work for them.) Some research studies have found that taking metformin for 4 to 6 months before starting Clomid treatment may improve success for women who are Clomid-resistant. Another option for women with Clomid resistance may be metformin combined with letrozole . If Clomid doesnt help you get pregnant, the next step is usually gonadotropins or injectable fertility drugs . Research has found that combination injectables with metformin may improve ongoing pregnant rates. One study found that combining metformin with injectables improved the live birth rate when compared to treatment with injectables alone. In this study, if the live Continue reading >>
Polycystic Ovarian Syndrome Fertility Treatment With Metformin (glucophage)
How Metformin Is Used for Polycystic Ovaries Polycystic ovarian syndrome is a common cause of anovulation and infertility in women. These women do not ovulate (release eggs) regularly and therefore have irregular menstrual periods. The ovaries have many small cysts (2-7 mm diameter) called antral follicles, giving the ovaries a characteristic "polycystic" (many cysts) appearance on ultrasound. A relatively new method of treating ovulation problems in women with polycystic ovarian disease is to use an oral medication called metformin (brand name is Glucophage). Metformin has traditionally been used as an oral drug to help control diabetes. Then, some smart doctor figured out that polycystic ovarian syndrome treatment with metformin can be very effective. If Glucophage alone does not result in ovulation and pregnancy, we often use: If the combination therapy is not effective, we can try: Metformin Use with IVF Treatment We also use Glucophage in women going through in vitro fertilization for PCOS, and for those with very high antral follicle counts - if their ovaries are "polycystic" by ultrasound. We find that some women with polycystic ovaries respond with a "smoother" response to the injectable FSH medication if they have been taking Glucophage. Risks and Side Effects of Metformin / Glucophage In about 25% of women Glucophage causes side effects which may include abdominal discomfort, cramping, diarrhea and nausea. The side effects may be severe enough to make the woman stop the Glucophage medication. We are not aware of any serious complications resulting from Glucophage treatment. Another oral medication used for diabetes called Troglitazone has been associated with liver failure and death in rare cases. This has been publicized on television shows, in newspapers, et Continue reading >>
- Type 1 Diabetes and Polycystic Ovary Syndrome: Systematic Review and Meta-analysis
- Polycystic Ovary Syndrome and Diabetes
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
Drug Treatments For Polycystic Ovary Syndrome
Polycystic ovary syndrome is a condition present in approximately 5 to 10 percent of women of childbearing age. Diagnosis can be difficult because the signs and symptoms can be subtle and varied. These may include hirsutism, infertility, menstrual irregularities, and biochemical abnormalities, most notably insulin resistance. Treatment should target specific manifestations and individualized patient goals. When choosing a treatment regimen, physicians must take into account comorbidities and the patient's desire for pregnancy. Lifestyle modifications should be used in addition to medical treatments for optimal results. Few agents have been approved by the U.S. Food and Drug Administration specifically for use in polycystic ovary syndrome, and several agents are contraindicated in pregnancy. Insulin-sensitizing agents are indicated for most women with polycystic ovary syndrome because they have positive effects on insulin resistance, menstrual irregularities, anovulation, hirsutism, and obesity. Metformin has the most data supporting its effectiveness. Rosiglitazone and pioglitazone are also effective for ameliorating hirsutism and insulin resistance. Metformin and clomiphene, alone or in combination, are first-line agents for ovulation induction. Insulin-sensitizing agents, oral contraceptives, spironolactone, and topical eflornithine can be used in patients with hirsutism. Polycystic ovary syndrome (PCOS) is not a simple pathophysiologic process for which one treatment addresses all manifestations. It is a condition that occurs in approximately 5 to 10 percent of women of childbearing age.1 It can affect women in many different ways; therefore, physicians must individualize treatment goals and target treatment to specific manifestations. Comorbidities (e.g., cardiovasc Continue reading >>
Pcos: Insulin And Metformin
Young women with PCOS often have elevated insulin levels and are more likely to develop diabetes. Metformin is a medication often prescribed for women with PCOS to help prevent diabetes. A lifestyle that includes healthy nutrition and daily exercise is the most important part of a PCOS treatment plan. What is insulin? Insulin is a hormone made by an organ in the body called the pancreas. The food you eat is broken down into simple sugar (glucose) during digestion. Glucose is absorbed into the blood after you eat. Insulin helps glucose enter the cells of the body to be used as energy. If there’s not enough insulin in the body, or if the body can’t use the insulin, sugar levels in the blood become higher. What is insulin resistance? If your body is resistant to insulin, it means you need high levels of insulin to keep your blood sugar normal. Certain medical conditions such as being overweight or having PCOS can cause insulin resistance. Insulin resistance tends to run in families. What can insulin resistance do to me? High insulin levels can cause thickening and darkening of the skin (acanthosis nigricans) on the back of the neck, axilla (under the arms), and groin area. In young women with PCOS, high insulin levels can cause the ovaries to make more androgen hormones such as testosterone. This can cause increased body hair, acne, and irregular or few periods. Having insulin resistance can increase your risk of developing diabetes. How can I lower my insulin levels? You can help lower your insulin levels naturally by eating fewer starches and sugars, and more foods that are high in fiber and low in refined carbohydrates. Low glycemic foods, on the other hand, don’t raise your blood sugar or insulin levels as much as foods that are high in sugar or refined carbohydr Continue reading >>
