Metformin and PCOS: What to Know

Managing PCOS and Pregnancy: The Role of Metformin

Metformin is a medication that is often used off-label to treat symptoms of polycystic ovary syndrome (PCOS). Most commonly, metformin is prescribed to women who suffer from polycystic ovary syndrome (PCOS) and are attempting to get pregnant. Metformin can help with a number of symptoms, including menstrual cycles, weight loss, high cholesterol, and heart disease. However, most commonly, metformin is prescribed to help with steadying menstrual cycles which helps with issues related to infertility.

Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose (sugar) in the blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. It’s commonly prescribed to help with the treatment of Type-2 diabetes.

Key Takeaways

  • Metformin is not prescribed to help treat polycystic ovary syndrome (PCOS), however, it is commonly prescribed to help increase fertility in women who are trying to get pregnant and have polycystic ovary syndrome (PCOS).

  • Metformin can be highly effective in increasing regular menstrual cycles in women who have polycystic ovary syndrome (PCOS), studies have found that up to 90% of women resumed regular menstruation within 6 months of starting their Metformin schedule. 

  • Metformin can be prescribed to patients who don’t have Type-2 diabetes. A primary care physician may prescribe this in an “off-label” use.

Why Metformin is Used to Help PCOS

Studies have shown that metformin, when used to treat the symptoms of polycystic ovary syndrome (PCOS), can significantly reduce serum androgen levels, improve insulin sensitivity, restore menstrual cyclicity, and can assist in helping to trigger ovulation. Which is usually an effective way to increase overall fertility.

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder, affecting 4%-12% of women and is the leading cause of infertility. Key symptoms include irregular menstrual cycles, anovulatory infertility, and elevated androgen levels, leading to diverse presentations across cases. 

It is recognized as a “syndrome” due to its variability rather than a single disease. Among those affected, 69% experience hirsutism, 74% infertility, 40% obesity, 50% amenorrhea, 29% functional bleeding, and 12% regular cycles. A significant association between the level of insulin and testosterone was observed in polycystic ovary syndrome (PCOS). It was obvious that IR is a popular feature of the disorder and is not relevant to obesity.

Metformincan improve ovulation in about 69% of women with polycystic ovary syndrome (PCOS). And normal menstrual cyclicity in 88% of patients. Which are fairly fantastic numbers based on the symptom of 74% of women experiencing infertility who suffer from polycystic ovary syndrome (PCOS). Metformin can also improve endometrial function, which can help with pregnancy.

Related: 5 Effective Signs Metformin is Working

Why Metformin Can Be Helpful in Pregnancy and Ovulation

Metformin is a drug that's typically used to treat Type 2 diabetes in patients. It works by improving insulin resistance, which is when cells in the body don't respond to insulin in the proper way. In most cases, metformin is prescribed to those who are trying to get pregnant and suffering from polycystic ovary syndrome (PCOS) symptoms.

Those suffering from polycystic ovary syndrome (PCOS) may want to lower some of the symptoms, of which metformin has been found to be quite effective. Here are some of the ways metformin has been known to help in the pregnancy process.

In fact, studies have found that up to 90% of women resumed regular menstruation within 6 months of starting their Metformin schedule. 

Insulin levels

Metformin lowers insulin levels, which can help with symptoms like irregular periods, hirsutism (unwanted hair growth), and acanthosis (darkening of the skin). 

Ovulation

Metformin can help induce ovulation in women with polycystic ovary syndrome (PCOS) who don't ovulate regularly. 

Weight loss

Metformin may help with weight loss, especially in overweight women with polycystic ovary syndrome (PCOS). 

Pregnancy

Metformin may reduce the risk of miscarriage, and some studies suggest it may be safe to take up to 12 weeks into a pregnancy.

Blood pressure

Metformin may reduce both systolic and diastolic blood pressure. 

Metformin, PCOS, and Those Not Trying to Get Pregnant

While it’s less common. It can be and would be prescribed to those who are strictly trying to subside some other types of common symptoms of PCOS. Metformin can help manage symptoms like irregular periods, acne, and excess hair growth caused by hormonal imbalances associated with polycystic ovary syndrome (PCOS), even if it also has the potential to increase fertility; therefore, appropriate contraception should be used if pregnancy is not desired.

Can You Be Prescribed Metformin Without Type-2 Diabetes?

Yes. Primary care providers are allowed to prescribe medications for purposes other than what they are approved for by the FDA. This is usually called “off-label” use. And because of metformin's safety, effectiveness, and the promising research to support its broader use, metformin is often prescribed off-label by providers.

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Sources

  1. Walling AD. Metformin for polycystic ovary syndrome. Am Fam Physician. 2003;68(11):2265-2266.

  2. Attia GM, Almouteri MM, Alnakhli FT. Role of metformin in polycystic ovary syndrome (PCOS)-related infertility. Edited by Muacevic A, Adler JR. Cureus. Published online 2023. PMCID: PMC10544455. PMID: 37791160.

  3. Nasri, H., & Rafieian-Kopaei, M. (2014). Metformin: Current knowledge. Journal of Research in Medical Sciences, 19(7), 658–664. PMCID: PMC4214027, PMID: 25364368.


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The content on this page is for informational and educational purposes only and does not constitute professional medical advice. Patients should not use the information presented on this page for diagnosing a health-related issue or disease. Before taking any medication or supplements, patients should always consult a physician or qualified healthcare professional for medical advice or information about whether a drug is safe, appropriate or effective.