Compliments
of the Muasher Center for Fertility
Fairfax, VA
Metformin
is currently being used to induce ovulation in women
with polycystic ovarian syndrome (PCOS). Metformin is
an insulin sensitizing drug originally used in the treatment
of diabetes. Metformin “reverses” insulin
resistance (hyperinsulinemia) thus effectively treating
many diabetics.
Up
to 40- 70% of patients with PCOS have hyperinsulinemia
which leads to excess androgen (male hormones) production
by the ovaries and increased production of LH by the
pituitary. The body tries to compensate for insulin
resistance by the “over production” of insulin.
Increased LH levels cause further elevations in androgens.
Clinically, this results in ovulatory irregularities
(or anovulation), increased body hair, numerous small
ovarian cysts, and a classic “pear shaped”
body appearance (obesity; although not always) and long
term negative health consequences such as diabetes.
Metformin
sensitizes the cells to insulin thus lowering the body’s
production of insulin and consequently reducing androgen
production. Once androgen production has been normalized
ovulation can often resume. Metformin is dosed at 500
mg three times per day and Clomid or FSH may be added
if ovulation is not established.
Numerous
studies indicate that metformin
as sole therapy is often effective in establishing ovulation
in PCOS patients. Metformin is not without side
effects and nausea is one of the most frequent.
PCOS
patients usually have exaggerated responses to medications,
such as FSH. Given the complexity of the disease, its
potential long term consequences,and difficulty to treat,
PCOS patients should seek the advice of a reproductive
endocrinologist.
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