Getting pregnant with PCOS: Metformin

Metformin is the most commonly used medicine in Type II Diabetes Mellitus.

In order to understand why a diabetes drug is used to treat PCOS, we first need to understand a few basics.

 Insulin is a hormone secreted by the pancreas. It signals the fat, liver and muscle cells (peripheral tissues) to absorb glucose in the blood to be used as energy, there by reducing blood glucose levels. Insulin resistance, commonly seen in PCOS, is a condition in which the body becomes less sensitive (hence, resistant) to the insulin that is being produced. This means that your body needs more insulin than the normal person to keep your blood sugar at normal levels.

What happens when there is an increase in circulating insulin?

It causes the ovaries to produce more androgens (male hormones) causing all the symptoms that we know are related to PCOS like irregular periods, increased body and facial hair, acne and male pattern baldness. Insulin resistance is also a warning sign that diabetes may develop later on.

How does Metformin help PCOS?

In theory, this drug helps improve PCOS symptoms by reducing the amount of insulin circulating in the body. Less circulating insulin means that the ovaries behave in a more normal manner, decreasing the amount of androgens secreted. Metformin reduces glucose absorption through the intestine, decreases the release of glucose by the liver and ultimately makes your body more sensitive to the insulin being produced.

How does Metformin help if you’re trying to conceive?

It has been seen in various studies that Metformin can help with weight loss especially when coupled with regular exercise. It has been seen to induce or restore ovulation, helping to regularise periods. Once you are able to conceive, Metformin again plays a role in helping to maintain the pregnancy and prevent early miscarriage.

My doctor advised me to start Metformin when we were ready to try for a baby.  I was told that it would improve my chances of ovulating and also in maintaining a future pregnancy.

Initially, I started with 500 mg  of Metformin, once a day for about two weeks. Then I was told to increase the dosage to twice a day.  I had diarrhea pretty much all the time that I was on Metformin, especially if I had a carbohydrate rich meal. This reduced a bit once I started taking sustained release Metformin 1000 mg or 1 gram once daily, after dinner.

Now, the good news with Metformin was that, I started getting periods more regularly. Periods that previously used to come only when I took birth control pills, now started coming on their own, albeit somewhat late. But something is better than nothing, especially when you’re trying to conceive.

The even better news was that, by charting my basal body temperature, I was able to establish that although my cycles were long, I was ovulating on my own. This gave me confidence, and a lot of hope that I could get pregnant on my own.

My cycles on metformin were as follows:

1st cycle: 52 days (ovulation day: cycle day 38)

2nd cycle: 53 days (ovulation day: cycle day 42)

3rd cycle : 34 days (ovulation day: cycle day 22)

4th cycle : 47 days  (ovulation day: cycle day 35)

The last cycle I never got my period though, because I was pregnant ! My basal temperature chart told me I had ovulated on day 35 of that cycle. If you notice, the third cycle is almost as short as a normal one. I remember that month, that I had paid close attention to my diet and exercise, cutting out as much refined food as possible.

I stayed on Metformin throughout my pregnancy, as per my doctor’s orders. I stopped it at around week 28.

In short, Metformin did help me. However, I do know that it is not the right drug for everyone and some women have severe side effects and are not able to tolerate it at all. Having said that, it is definitely worth a shot to ask your doctor whether you can try it out.

**Please note that I am not a medical professional, and I do not advise you to take any medication without consulting a doctor. What worked for me may or may not work for you. Taking medication without doctor’s advice is never a good idea. I am merely stating my experience in this blog post.**

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