PCOS, or Polycystic ovary syndrome, is a condition that arises in between 5% and 10% of women of childbearing age as a result of an imbalance in reproductive hormones. Women in PCOS have highly elevated levels of male reproductive hormones (androgens). Polycystic ovaries develop as a result of being stimulated by too many androgens, especially testosterone. The cause of PCOS is unknown, although it is believed it has a hereditary component. There seem to be two main driving forces behind the development of PCOS – high level of male hormones (androgens) and high level of insulin.
The symptoms of PCOS include irregularities in the menstrual cycle (no periods, or very heavy periods), excess facial hair, excess body hair, areas of darkened skin, pelvic pain, difficulty getting pregnant or infertility. Some other conditions are also associated with PCOS. For example, half of the women with PCOS is estimated to get diabetes or pre-diabetes by age forty. PCOS – affected women sometimes also tend to have high blood pressure, high levels of bad cholesterol, sleep apnea, endometrial cancer and some other conditions.
PCOS, Metformin, and Diabetes
PCOS and diabetes are often connected because, as stated above, around 50% of women with PCOS will also have diabetes at a certain point in their lives. Apart from this connection, women with PCOS are often treated with metformin, the same drug that is used to treat type 2 diabetes, to manage their PCOS and increase their fertility. Studies have found that one of the reasons behind PCOS is insulin resistance. Insulin resistance leads to the compensatorily increased production of insulin by the pancreas, which, in its turn, leads to the increase in the levels of male hormones (androgens) in the body. The increase of androgens is the main cause of PCOS. This is the link that connects Insulin Resistance and PCOS, and this is why metformin is often used to help treat PCOS.
Studies that looked at patients with PCOS taking metformin have observed significant improvement in menstrual cycle regularity and reduction in androgen levels as well as a significant reduction in body weight of the subjects. In real life treatment, metformin, particularly Glucophage, has been proven to be very effective in treating PCOS and increasing female fertility, by the mechanisms of reducing insulin resistance, helping control blood sugar levels in the body and decreasing the amount of androgens in the system. This in its turn helps reduce the number of cysts and prevent the development of new ones. Metformin has also been proved to help induce ovulation in women with PCOS struggling with fertility.
If you are suffering from PCOS, your doctor may also prescribe other medications such as fertility treatment drugs such as Clomid. Since there is an association between PCOS and insulin resistance, lifestyle modifications should include exercise and monitoring caloric consumption to maintain proper blood sugar levels.
Miscarriage risks and metformin
Women suffering from PCOS have been shown to have a much higher risk of miscarriage than women that don’t (three times as high for women with PCOS as opposed to healthy women). In many cases, this can be connected to the prevalence of obesity in PCOS women. However, that has not been sufficiently researched. Metformin has been shown to have a positive impact on reducing risks of miscarriage for women with PCOS.
Gestational diabetes and metformin
Women that have PCOS also have a higher chance of developing gestational diabetes during their pregnancy. The reverse is also true: women with a history of gestational diabetes have as much as 40% chance to develop PCOS at some point in their lives. Gestational diabetes is not only bad for the mother. It can also negatively affect the fetus and cause abnormalities, developmental issues, and even death. Medicating with metformin throughout pregnancy has been shown to greatly reduce the risk of PCOS women developing gestational diabetes, thus greatly improving their chances to carry the pregnancy to term and have a healthy child.
Other health issues you may need to know about if you are diagnosed with PCOS
*More than half of women suffering from PCOS will get diabetes.
*A woman affected by PCOS will have 4-7 times greater chance of experiencing a heart attack compared to one of the same age who doesn’t have PCOS.
*A woman who is suffering from PCOS is at higher risk for high blood pressure.
Metformin has been shown to be very effective in a whole range of conditions related to insulin resistance and Polycystic ovary syndrome. However, the long-term use of metformin to treat PCOS has not been studied extensively. Follow your doctor’s advice about how long you should use metformin and in what dosage. Although metformin has shown some great results, it is still not a replacement for a healthy lifestyle, including physical activity and well-balanced diet. If you are suffering from PCOS or having troubles with fertility, please consult your doctor to develop a program you can follow to maintain an overall healthy lifestyle. Exercising and healthy diet should be an important part of any medical treatment.
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Dr. Randall C. Labrum, Clinician, Researcher and Author