PCOS, Metformin and Infertility

Polycystic ovary syndrome (PCOS), the most common endocrine disorder among women between the ages of 18 and 44, is a condition marked by abormal menstrual cycles and symptoms related to elevated androgens (male hormones) in females.such as excess body and facial hair, acne, difficulty getting pregnant, and patches of thick, darker, velvety skin. Associated conditions may include type 2 diabetes, obesity, obstructive sleep apnea and heart disease.

When woman with PCOS are trying to conceive we use a combination of ovulation-inducing agents such as Clomid® (clomiphene) or FEMARA® (letrozole) along with metformin which seems to help improve the response to the ovulation drugs. Efforts to improve fertility may include lifestyle changes such as weight loss and exercise. Sometimes metformin alone may improve menstrual function and promote fertility. According to an article published in the Journal of Clinical Endocrinology & Metabolism, women diagnosed with polycystic ovary syndrome (PCOS) placed on metformin for 24 months may experience improvements in menstrual cycle and hormone profiles.

During the study, the women were stratified according to either body mass index (BMI) or testosterone status, creating 4 subgroups: normal weight-normal testosterone, normal weight-elevated testosterone, overweight-normal testosterone, and overweight-elevated testosterone. Regardless of whether the women were stratified by testosterone or BMI, the percentage of women found to have normal menstrual cycles after being treated with metformin were generally higher when compared with baseline values. Women in the normal weight subgroup were noted to show significant improvement after 3 months when stratified based upon BMI.

Researchers concluded that metformin is associated with improvements in menstrual cycle regularity and hormonal patterns in normal weight and overweight women with PCOS placed on metformin drug therapy for 24 months. The greatest improvement from baseline was in the normal weight-elevated testosterone subgroup, and the longest duration of improvement was in the overweight-normal testosterone subgroup. There are differences in women’s responses to treatment with metformin as influenced by BMI and testosterone phenotypes.

In any case, women with PCOS and infertility should consider using metformin to improve their menstrual function and/or as an adjunct to ovulation inducing medications.

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