Metformin and PCOS

[L.Mayhem]

I posted a couple weeks ago outlining my fertility issues--but the crux of them seem to be PCOS and/or endometriosis. I am almost 26 years old, was diagnoses with PCOS (and possible hypothyroidism) about 10 years ago, and the endo was diagnosed through laproscopy about 4 years ago. I've been off an on birth control, synthroid, and metformin since then. I got pregnant over the summer and had a miscarriage. Since then, my cycles have been even more irregular-- I've had only 3 (varying length and intensity) periods in the past 8 months. I've been attempting to chart BBT and using OPKs, but I can't seem to detect ovulation for certain.

I went in for an appointment today for my annual exam and we discussed medicating for the PCOS, etc. I'm going back on the Metformin and working up to a final dosage of 1000mg 2x daily in hopes of regulating my cycle. I am curious about other women who have similar issues and have used Metformin in hopes of getting pregnant--what were your results like? Does anyone know scientifically how Metformin works to treat PCOS/aid in pregnancy?

Thank you in advance for any information you can provide me with.

[Masel]

i finally went to an endocrinologist between periods of wanting to concieve. She concentrated on just getting my body to run better and put me on met and synthroid. It didn't happen immediately but eventually I had regular ovulatory cycles. We needed some additional help concieving my 7 month old baby because DH had a less than idea count.

Anyway, going on metformin and synthroid helped me a lot! Many other hormonal things started going better after them too.

[soso-lynn]

Both endometriosis and PCOS can cause irregular cycles. You say you were diagnosed 10 years ago, when was your last follicular ultrasound? Also, did you get an AMH test done?

Hypothyroidism can also cause irregular cycles and can reduce your fertilty as well as make it a risky pregnancy or even cause miscarriages. Even sub-clinical hypothyroidism can have an impact, so it is extremely important to regulate that before attempting a pregnancy.

What metformin does is decrease your resistance to insulin (meaning you need less to get the job done). A side effect of that is reduced testosterone (which is the cause of PCOS-associated hirsutism, acne, weight gain distribution, etc). In turn, this can regulate your menstrual cycle, thus increasing your chance of pregnancy. It works very well for those whose problem lies with their insulin resistance but it might not help if you do not truly have PCOS but rather simple PCO, not part of a syndrome.

So, if I where you, I would get futher investigations for the thyroid issues and go on synthroid even if the problem appears to be mild or borderline. Once the thyroid is fully regulated (at least 6 weeks post beginning of synthroid), I would either wait and see if your cycles get more regular or start metformin right away (depending on how anxious you are to get pregnant faster vs avoiding unnecessary meds and side effects). I would also, in parallel, get a further investigation to evaluate the curent state of your endometriosis as well as a standard fertility workup (if not done yet).

Once all that is taken care of, if you still do not ovulate regularly or if you want to speed things up, I would consider gentle stimulation, perhaps femara or clomid or very low dose FSH (injections) to get an ovulation and a regular cycle.

So, in short, the most important thing to take care of (perhaps with a good endocrinologist) is your thyroid.

[IdahoMom]

Studies are starting to show that in women with PCOS, metformin can decrease incidence of miscarriage, as well. As for me, my first 2 were IVF babies and I was told I'd never conceive any other way since I just don't ovulate. My 3rd was a spontaneous pregnancy (best surprise ever!) while I was on met just to treat PCOS. It doesn't seem to be so easy this time, but it worked then! Good luck!

[Grace and Granola]

I was on metformin for a long time with very little effect to my pcos. I finally ended up seeing an herbalist who created for me a very specific formula that addressed each of my pcos symptoms. I was pregnant within 4 months, then had a surprise pregnancy with no help when my ds1 was 7mos old. I don't want to be discouraging, but the reality is that met is not a miracle drug for everyone with pcos, BUT that does not mean there is no hope for you! Best of luck to you

[Masel]

One weird thing about being on metformin for PCOS is that you will constantly have to remind people that you do not have diabetes. I had surgery on my knee recently and had to list what meds I'm on and each time someone went over the list they said something about this. I also got a letter from my new insurance company going on about diabetes. Great.

[seattlelady]

I started on a combination of Armour and Synthroid about 6 years ago, keeping my TSH at about 1.5. Subsequent to my diagnosis of Hypothyroid/Hashimoto, I was diagnosed with PCOS and referred to an Endo. I took Metformin for about 6 months the first time, stopping because I did not like the side effects. When we decided to start trying to conceive(May 06) I agreed to try Metformin again. I was on it for 3 months prior to attempting to conceive my daughter. We conceived the first month we tried. I stayed on Met through the first trimester and also used progesterone cream as prescribed by my Naturopath for the first trimester.

Since my daughter was born(Feb 07) I have had a 'regular' cycle. Up until about 6 months ago it varied from 28-33 days in length and I could tell when and from which ovary I ovulated. For the past 6 months I have had regular 28 day cycles. My other hormonal side effects have also diminished since childbirth(PMS, Acne, Bloating) My daughter also exclusively breastfed for the first 8 months and only had breastmilk or water until she was 3+ years old. I think pregnancy and breastfeeding really helped regulate my hormones.

We are going to try to conceive again this Fall and I decided that I am going to go back onto Metformin again. I am a bit conflicted because I have had such positive changes(the only thing that hasn't changed is my excess weight) since having my daughter. I wonder if I really need the Met to conceive again and prevent miscarriage. At the same time I know that I had a positive outcome while taking Met before and want the same outcome for #2.

At any rate, I guess I am here to share that Met worked for me with #1. I wish you the best as you try to conceive again.