Metformin for PCOS and PCOD: Uses, Health Benefits, and Side Effects

Polycystic Ovarian Disease (PCOD) and Polycystic Ovarian Syndrome (PCOS) are different yet have similar symptoms and causes. Higher volumes of androgens and the cells resistant to insulin are the common issues women with PCOS and PCOD encounter. And approximately 60-80% of women with PCOS/PCOD have insulin resistance. 

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In Insulin resistance, the cells rarely recognize insulin, subsequently failing to convert the blood glucose into energy. This creates a dearth of insulin among the cells and a rise of blood glucose levels. The pancreas works extra hard to produce more insulin, increasing the circulating insulin in the body. This develops certain conditions within the body like,

• Hyperinsulinemia- Excess insulin secretions
• Type 2 diabetes- High glucose in the blood
• High cholesterol- Increased triglyceride levels
• Obesity- Inflammation and weight gain
• Fatty liver condition- Non-alcoholic condition

Insulin resistance also gives rise to PCOS/PCOD features such as;

• Hyperandrogenism- Elevated androgens
• Development of follicular cysts in the ovaries
• Anovulation or Oligoovulation- Infrequent periods

Metformin is an insulin-sensitizing drug typically prescribed for women having insulin resistance and PCOS. 

Through this article, let’s learn the mode of action, additional benefits, and possible side effects of Metformin in PCOS women. 

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Metformin: How does it work?

A member of the biguanide family, metformin has been one of the commonly used drugs for diabetes treatment for many years. It is the first insulin-sensitizing drug used in PCOS treatment.

The liver/hepatic cells absorb the drug, spreading its mechanism and improving the cell’s sensitivity to insulin. This significantly reduces the circulating insulin levels. The excess metformin gets accumulated in the intestines, regulating glucose absorption. 

In PCOS, metformin works by ameliorating insulin sensitivity and peripheral glucose uptake by the cells. The cells naturally absorb the readily available glucose instead of synthesizing it with extra cell labour or activity.

The ways metformin works in lowering blood glucose are mentioned below.  

Metformin: Other Health Benefits

In PCOS and PCOD women, the high amount of insulin in the body triggers the release of insulin growth factor (IGF-1) that can directly affect the ovaries. The ovaries tend to release more testosterone (androgen-male hormone), leading to aggravated PCOS/PCOD symptoms. Metformin breaks this continuous cycle of events that utilizes the body’s insulin properly, thus cutting off the consequent cyclic effects.

Here are some of the other health benefits of Metformin. 

• De-escalates cholesterol levels, triglycerides, and fatty acids in the bloodstream.
• Reduces hypertension, and dyslipidemia (abnormal lipid profiles).
• Reduces androgen production (hyperandrogenism).
• Regulates ovulation and menstruation.
• Help reduce weight.
• Helps recede PCOS symptoms, including infertility

The long-term preventive value benefits of these PCOS tablets include:

• Prevents type 2 diabetes among PCOS/PCOD women.
• Lowers the risk of miscarriages.
• Helps prevent and treat gestational diabetes in women with PCOS/ PCOD. 
• In pregnant women, it reduces the risk of pregnancy-induced hypertension and preeclampsia (persistent high blood pressure during pregnancy).
• Lessens the risk of cardiovascular diseases and endometrial cancer.

The Wider Benefits of Metformin, when used before or during In Vitro Fertilization (IVF), 

• Helps improve oocyte and embryo quality in PCOS women.
• Reduces the risk of Ovarian Hyperstimulation Syndrome (OHSS).
• Improves clinical pregnancy and live birth rates.

Metformin: Possible Side Effects

Prescribed and safe doses of Metformin for PCOS range between 500 mg to 2550 mg per day. It is a safe oral medication when used in the recommended dosage. It rarely causes mild side effects, commonly observed in the initial days of administration. 

• Feeling sick with gastrointestinal issues like a stomach upset, stomach pain, gas, bloating, nausea, diarrhea. 
• Long-term use or higher doses of Metformin increase the possibility of vitamin-B12 deficiency.
• Overdose of Metformin can lead to a buildup of lactic acid (lactic acidosis) in the blood, causing chronic kidney problems.

However, the probable side effects can be limited by,

• Introducing Metformin with low doses and gradually increasing the doses. This can help the body to get accustomed to the new medication.
• Taking Metformin with food minimized the side effects.
• Taking an extended-release version of Metformin (Metformin ER) to allow release and absorption of Metformin for an extended time makes it gentler and more tolerable for the digestive system as well.
• Supplement the diet with additional B-12 to restore normal B-12 levels.
• People having Kidney issues must strictly avoid Metformin. Excessive alcohol intake while on Metformin can increase the lactic acidosis risk. 

Conclusion/Take-Away

Metformin used to treat diabetes for years has broader application in PCOS/PCOD problem treatment. These PCOS/PCOD tablets work by improving the sensitivity of the cells to insulin, simultaneously reducing circulating insulin and blood glucose levels. Along with various long-term benefits it carries, Metformin has shown better results when used by PCOS/PCOD women undergoing assisted reproductive techniques (ART) procedures. The mild side effects too can be limited and taken care of with proper guidance from an expert or specialist. 

References:

Overview | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200666/ 

Overview | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475283/