Does metformin help PCOS? A Pharm.D answers

Does metformin help with PCOS? Pharmacist

As a pharmacist who specializes in hormones, I get a lot of questions about taking metformin to help PCOS, as well as tips on lifestyle changes for PCOS. When you (finally) get a diagnosis of PCOS, it can feel really confusing. Usually, the treatment plan you are given isn’t much of a plan at all—unless you are trying to conceive. If fertility is not a part of your health goals, or even if it is, a clear understanding of PCOS and the medications and lifestyle changes used to manage it are key pieces to healing.

PCOS doesn’t just involve and impact your hormones

PCOS impacts a lot of areas in a woman’s day-to-day life. It may seem like it’s a condition that stays in the box of reproductive hormones. However, it can be a source for so many other lifestyle-impacting conditions and symptoms. Other conditions sometimes linked to PCOS:

  • Sleep apnea
  • Altered cortisol (stress hormone) production
  • Thyroid function
  • Changes in melatonin release (a hormone that promotes sleep and wake cycles)
  • Increased frequency in anxiety or depression
  • Decreased physical activity due to daytime sleepiness
  • Turning to smoking, alcohol use to deal with symptoms

So often, no one explains PCOS in terms of what’s happening in the body or root cause. Our brain is the central operating center for the body. It controls and regulates all signals, from fat cell production to sleep engagement. But when you have a system built on a single processing unit, a hiccup from one spot can produce effects all over. This is why a condition such as PCOS affects a lot of varying aspects of your health and can be difficult to pinpoint an exact cause (research is still ongoing).

The point here is that, as a female, everything is going back to your hormones. Which means that a lifestyle that addresses PCOS through support and stabilization has the power to improve not just your periods, but the entirety of your wellness.

Medications that are commonly recommended with PCOS

Currently, PCOS treatment is symptom-based. That means medications are utilized with the goal of minimizing or correcting symptoms that led to diagnosis. Or, to increase fertility. For example, restoring ovulation and regularity of menstruation. Alleviating unwanted hair growth. Reducing risk for pre-diabetes. And lowering BMI or body weight. Typically, because of medication side effects, you get presented with options to restore ovulation and fertility. Or, to provide long-term maintenance of PCOS-related symptoms.

The most common medication regimen recommended in long-term PCOS symptom management is metformin and/or birth control. Per guidelines, physicians should also be providing lifestyle changes for PCOS, along with support and management counseling—in addition to metformin prescriptions. However, often in clinical practice, I have seen this step overlooked.

Will metformin help PCOS or treat it?

PCOS is lifelong, and there is no medication that can solve it. Medications like metformin (or birth control) are not treating the PCOS itself; but, rather, reducing risks and symptoms associated with glucose intolerance, cardiovascular impacts, or cycle regulation.

Metformin for PCOS

Metformin may help the symptoms of PCOS but it does not heal PCOS. It helps regulate blood sugar, which can help reduce cysts, improve glucose tolerance, and lower diabetes progression risks. In some women with PCOS who have anovulatory cycles, it can help promote ovulation. Some studies show that without lifestyle changes, there are limited benefits from metformin in women with polycystic ovarian syndrome.

Metformin does have side effects. If you decide to try metformin for PCOS, your physician or provider and pharmacist should ask if you have any questions about how it works and what you could be feeling while on it. For most people, metformin’s side effects go away after two weeks (from starting or raising the dosage). Some common side effects of metformin are:

  • Diarrhea
  • Upset stomach
  • Nausea
  • Bloating

As you adapt to the medication these side effects should lessen and tolerating the medication becomes easier. A tip to overcome this is taking your tablets in small dosages (asking for a lower dosed tablet or extended-release tablet) and taking it prior to bedtime (as this is when your digestive system slows down a bit). You can also experience weakness, fatigue, low blood sugar, and low levels of vitamin B12. If you are taking metformin long term, consider supplementing with a methylated B12 product. 

One piece of information left out of metformin counseling? Time it away from high-fiber meals. You should also limit wine and other alcohol while taking it. (That’s good for your hormones anyway!)

Will birth control help my PCOS?

So what about those with PCOS without cysts? Or those with chronic low blood sugar (indicating a lack of glucose intolerance) and PCOS? Birth control usually gets prescribed. But hormonal birth control does not treat PCOS, and that’s something your physician or healthcare provider should tell you.

Hormonal birth control simply turns off your natural hormone production and supplies you with synthetic ones instead. This allows for correction of irregularity in ovulation in menstrual cycles. But these synthetic hormones do not have the same needed and beneficial effects on the rest of the body (such as progesterone and testosterone).

Are there lifestyle changes that can help my PCOS?

Experts in traditional medicine and holistic realms agree lifestyle changes make up the foundation for PCOS management. These changes should not be the simple instruction to lose weight, exercise more, and eat less. (Although, I know these have been given to PCOS warriors all too often.)

From a holistic standpoint, it is not uncommon to find practitioners that believe PCOS can be treated and healed. You may always have more sensitive hormone fluctuations, require intentionality in your lifestyle, or continue experiencing some symptoms at times. However, you can also be fully knowledgeable of how to navigate those changes. This helps you restore your hormone balance and fertility. And, it lets you manage PCOS in a way that promotes empowerment and healing—with or without the help of medications, when necessary.

Heather Rhodes, Pharm.D.
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