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Metformin and PCOS: Health Benefits and Side Effects

Written By: Nikhita Mahtani

If you have PCOS, you’ve probably tried everything to help the symptoms, including diet and exercise changes, stress reduction, and so much more. But as much as you try, it may seem like nothing’s been helping. So, it’s no wonder why metformin, a popular drug primarily used for treating high blood sugar, has started being prescribed for those with PCOS. Usually recommended for people with type 2 diabetes, metformin works by controlling insulin resistance. According to the Food and Drug Administration, the role of metformin is to control blood sugar by both decreasing the amount of sugar the liver makes, as well as decreasing the amount of sugar the intestines absorb from food. This helps the body maintain a normal level of insulin, since blood sugar levels remain stable.

The thing is, although it may be a popular treatment plan for PCOS, does metformin actually work? Here’s what the experts have to say.

What is PCOS?

To understand why metformin is commonly prescribed for PCOS, it’s essential to understand exactly what PCOS is. Also called Polycystic Ovarian Syndrome, PCOS is a hormonal disorder that affects over 5 million women per year. The ovaries develop cysts or fluid filled sacs, which then affect fertility levels. This is usually caused by the development of excess male hormones (androgens) in the body, though why this happens is unknown. The symptoms of PCOS vary per person, but the most common ones include sudden weight gain, irregular or loss of periods, enlarged polycystic ovaries, acne, excess facial or body hair, and a rise in male hormone levels. The symptoms can go on for years if untreated, and can lead to infertility down the road. So, yeah… scary stuff.

Why is Metformin Prescribed for PCOS?

It’s kind of weird that doctors would prescribe a blood sugar medication for a hormonal disorder, right? Well, kind of. Unfortunately, PCOS can’t be cured, but it can be managed. Since most of the time, the weight gain associated with PCOS comes from excess insulin production, doctors recommend metformin to deal with that symptom specifically. The theory is that in the case for most women with PCOS, their cells are insulin resistant. This causes blood sugar to rise and the body to produce even more insulin, which is thought to be directly related to excess androgen production. So, essentially, by allowing the body to regulate insulin production, metformin also reduces the likelihood of excess androgen production. 

What are the Side Effects of Metformin for PCOS?

Unfortunately, metformin doesn’t come without a whole slew of side effects, including (but definitely not limited to) diarrhea, vomiting, stomach pain, loss of appetite, and nausea. It can cause low blood sugar, which could result in fainting or headaches. It can also promote fertility, so if you’re sexually active while on metformin, be sure to use adequate contraception.

Does Metformin Help Weight Loss on PCOS?

Well, it could, but it’s a toss up. Researchers aren’t 100 percent sure how metformin works, with some saying it reduces appetite, while others theorizing that it changes how the body stores fat. Either way, the results aren’t really all that staggering: A 2012 study from the American Diabetes Association determined that metformin really isn’t a quick fix, and that diet and lifestyle changes could matter more long term. The study, which tracked the use of metformin over an eight year period through both a placebo and a trial group, found that the average weight loss for people on metformin was only about four to seven pounds, and happened gradually over a few years. Essentially, it can help, but not without other lifestyle changes on the patient’s part.

Should You Take Metformin for PCOS?

While metformin can help with weight loss, and therefore could reduce androgen production amongst those with PCOS, it isn’t a quick fix. It definitely has some serious side effects, and even beyond that, it has been criticized by some doctors as essentially being a band-aid solution that fixes the symptoms behind PCOS, but not the underlying cause. If you’re struggling with weight and find that nothing is working, maybe start by talking to your doctor and seeing if metformin and which dosage might work best for you. Just don’t think of it as a cure all: it works best if you manage your diet, stress levels, and exercise routine as well.