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Navigating PCOS can feel overwhelming—especially when TTC. If fertility struggles have you searching for answers, you’re not alone. One treatment that’s gaining traction is metformin.
Metformin improves insulin sensitivity. This is good news since insulin resistance affects 50-70% of women with PCOS.
While metformin isn’t the fertility drug of choice for polycystic ovary syndrome—it’s often prescribed “off-label.”
So how does metformin help PCOS? And can it help you get pregnant?
Read on to find out! We’ll cover the benefits of metformin for PCOS and how it affects your fertility.
Takeaways
- Metformin is a diabetes medication that lowers blood sugar and improves insulin sensitivity.
- Insulin resistance is common among women with polycystic ovarian syndrome. It can imbalance other hormones and lead to high androgen levels.
- Metformin is prescribed “off label” to treat PCOS symptoms like acne, hirsutism, and infertility.
- It’s often combined with clomiphene citrate to induce ovulation and boost fertility.
- Metformin can help regulate menstrual cycles, restore ovulation, and improve pregnancy rates.
- It can also aid with weight loss, which can further ease PCOS symptoms.
- On average, it takes metformin about six months to regulate the menstrual cycle.
- An effective dose of metformin is between 1,500 to 2,550 mg per day. Discuss what’s the best dose for you with your doctor.
- Metformin therapy can lead to some side effects, especially at first. Tummy troubles are most common like nausea, diarrhea, gas, and bloating.
- If you have PCOS and are trying to get pregnant, talk with your doctor to see if metformin is right for you.
What is metformin?
Metformin is a medication best known for treating type 2 diabetes. People with this condition don’t respond to insulin properly, the hormone that helps your cells use glucose as energy.
This is known as insulin resistance—and it can lead to high blood sugar levels (a.k.a. high blood glucose). And that’s where metformin steps in. Metformin helps lower blood glucose levels and improve insulin sensitivity.
While metformin is mainly used for diabetes, it can also be helpful for polycystic ovary syndrome (PCOS). Wondering how? Keep reading!
How does metformin help treat PCOS?
Before we dive in let’s do a quick refresh on PCOS.
Polycystic ovary syndrome (a.k.a. PCOS) is a condition that causes irregular periods, ovulation issues, and infertility. It affects roughly 4-18% of reproductive-age women.
Women with PCOS have high levels of androgens (male hormones) and luteinizing hormone (LH). Some also develop ovarian cysts, hence the name polycystic ovarian syndrome.
On top of that, many women with PCOS suffer from insulin resistance. Meaning their bodies don’t use insulin effectively.
Unfortunately, this can trigger a cascade of other imbalances that affect fertility. Here’s what this means:
- Insulin resistance hinders the production of sex hormone-binding globulin (SHBG). This protein binds to sex hormones and helps regulate them.
- Low SHBG can increase testosterone levels.
- High androgen levels (such as testosterone) can interfere with ovulation.
This can create a vicious cycle—and that’s where metformin comes in handy.
Metformin improves insulin sensitivity and helps reduce testosterone levels.
This can ease PCOS symptoms like weight gain, acne, and excessive body hair (hirsutism). And this can also help regulate menstrual cycles, improve ovulation, and make it easier for women with PCOS to get pregnant.
How effective is metformin?
According to research, metformin appears to be an effective treatment option. But it’s not a first-line fertility treatment for PCOS. That honor goes to clomiphene citrate (a.k.a. Clomid®).
That said, metformin is often used in combination with clomiphene. Especially in women who failed to ovulate from clomiphene alone (clomiphene citrate-resistant PCOS).
So what does metformin do for PCOS?
Here’s what the science says about the benefits of metformin for PCOS:
Helps restore ovulation
Anovulation (lack of ovulation) is the leading cause of infertility. And up to 90% of anovulation-related fertility issues are due to PCOS. The good news? Metformin may help.
Studies show metformin is nearly four times as effective at inducing ovulation as a placebo. On top of that, adding metformin to clomiphene was more effective at triggering ovulation than using clomiphene alone.
Lowers risk of OHSS
If you have PCOS, metformin may help the IVF process go more smoothly. It lowers the chances of ovarian hyperstimulation syndrome (OHSS), a complication of IVF. Women with PCOS are nearly 14 times more likely to suffer from OHSS than women without PCOS.
In OHSS, the ovaries overreact to ovulation medications, making them swell and leak fluid. It can be dangerous if left untreated. Luckily, metformin helps reduce the risk of severe OHSS by 70%.
Increases pregnancy and live birth rates
Metformin may also help women with PCOS get pregnant quicker. When used in tandem with ovulation meds like clomiphene, it’s shown to significantly increase pregnancy and live birth rates.
However, the benefits seem to vary depending on the patient’s weight. One study gave metformin to non-obese women with PCOS. Metformin improved pregnancy rates better than placebo, but only slightly (47.7% vs 42.9%).
Reduces miscarriage rate
Metformin may also help PCOS patients stay pregnant. One small study compared miscarriage rates of women with PCOS who took metformin or didn’t. In the control group, 41.9% of women had an early pregnancy loss. In comparison, only 8.8% of women in the metformin group miscarried.
Impressive, right? Metformin boasts other benefits besides fertility though. It can lower insulin levels, blood pressure, and LDL “bad” cholesterol. On top of that, it can make it easier for women with PCOS to lose weight.
How long does metformin take to work for PCOS?
It varies from person to person. But on average, it takes metformin about six months to get the menstrual cycle back on track. After six months of use, over 40% of patients have a normal menstrual cycle.
That said, other symptoms like acne, hirsutism, and weight gain may improve in as little as eight weeks.
When starting new meds, it’s normal to feel impatient and want results right away. But remember—small improvements can lead to big changes over time.
Dosage of metformin
So what’s an effective dosage of metformin? Well, it varies since all PCOS journeys are unique. Yet experts say the sweet spot is between 1,500 to 2,550 mg per day.
But it’s best to gradually work up to this dosage. This helps your body slowly adjust to reduce the risk of side effects. A typical starting dose is 500 mg once per day taken with the largest meal.
As tolerance builds, the dosage is increased to 500 mg with each meal over several weeks. It usually takes at least 1,000 mg per day to see benefits for PCOS.
Before trying any new medication, it’s important to know the potential side effects. So let’s cover what you might notice when starting metformin.
Side effects of metformin
All in all, metformin is considered a safe treatment for PCOS. But like all medications, side effects are possible.
Gastrointestinal side effects are the most common symptoms, which may include:
- Nausea
- Diarrhea
- Gas
- Bloating
- Loss of appetite
- Abdominal pain
- Metallic taste
Side effects can be frustrating when starting new medications. The good news is symptoms usually fade as your body adjusts to metformin treatment.
Other potential side effects include:
- Malabsorption of vitamin B12 (which can lead to a vitamin B12 deficiency)
- Lactic acidosis can occur in rare cases, mainly in diabetic patients
Quick heads up: Lactic acidosis is a serious medical condition. It can cause exhaustion, muscle cramps, nausea, and rapid breathing. If you take metformin and experience these symptoms, seek help immediately.
Metformin may not be a good fit for women with kidney failure or severe liver disease. These conditions can increase the risk of lactic acidosis.
If you’re unsure if metformin’s right for you, talk with your doctor.
How to overcome side effects
If you start metformin and symptoms pop up, hang in there. Most side effects resolve on their own in a few weeks.
But in the meantime, here are some things that may lessen side effects:
- Start low and go slow. Give yourself time to build up a tolerance. Stick with a low starting dose of 500 mg once per day for 1-2 weeks. If tolerated, your doctor may up your dose by 500 mg each week or two until you reach the right dosage.
- Always take it with food. If possible, try to take metformin during or right after meals. This can make a big difference with tummy troubles.
- Avoid sugary foods. High-sugar foods and refined carbs (e.g. white bread, pasta, and white rice) can spike your blood sugar. This can make it harder to absorb metformin. Instead, opt for complex carbs like legumes, whole grains, or sweet potatoes.
- Take extended-release metformin. It absorbs slower into the bloodstream and has a lower risk of side effects.
Alternatives to metformin
Metformin is a popular treatment for PCOS. But it’s not the only option out there. Other medications and lifestyle changes can ease PCOS symptoms and support fertility too.
Here are a few alternatives to consider:
- Fertility medications. Clomiphene citrate and letrozole are still the drugs of choice for PCOS-related infertility. These meds stimulate ovulation and are often more effective than metformin alone.
Learn more: Clomid® vs. Letrozole: A Complete Comparison
- In vitro fertilization. If women don’t respond to ovulation medications, fertility procedures like IVF treatment may be recommended.
- Birth control pills. Oral contraceptives can help regulate hormones and lower androgen levels. This can ease pesky symptoms like acne and hirsutism and make menstrual cycles more regular.
Learn more: How Soon After Stopping Birth Control Can You Get Pregnant?
- Spironolactone. This medication is another option to treat acne and hirsutism (unwanted hair). But spironolactone isn’t considered safe if you’re TTC.
- Weight loss. Shedding just 5-10% of body weight can improve insulin resistance, restore ovulation, and regulate cycles.
- Balanced diet. Your food choices can calm PCOS symptoms, or aggravate them. The best diet for PCOS is rich in high-fiber foods, lean protein, healthy fats, and low-glycemic carbs. This keeps your blood sugar steady to ease symptoms.
Learn More: Your Guide to the PCOS Diet: What is the PCOS Diet?
Whether you opt for medications, lifestyle changes, or a combo of both—work with your doctor to find the right treatment plan for you.
Being a PCOS warrior can be challenging. But with the right support you can take meaningful steps to improve your fertility. If you’d like more support on your fertility journey, your Inito Family is here for you.
FAQs
To get pregnant with PCOS, focus on improving ovulation. Lifestyle changes like a well-balanced diet, weight loss, and exercise may help. Fertility medications like clomiphene citrate, letrozole, or metformin may be prescribed too. To learn more check out this Get Pregnant with PCOS Guide.
The lowest recommended dose for PCOS is 1,500 mg per day, taken over three meals. But it’s best to start at a low dose (like 500 mg) and slowly work your way up. This gives your body time to adjust to metformin and reduces the risk of side effects.
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