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Question of the Month

Q: I am interested in you opinion of the use of Metformin in women with PCOS in order to help regulate menstruation, regulate ovulation and increase chances of fertility.
Thank-you in advance for considering my question.

My article on PCOS will be posted soon.

A: Current view is that PCOS is due to insulin resistance. In this situation, the body cannot respond properly to insulin and so levels go up. These high insulin levels act on the theca cells in the ovary to cause them to make more testosterone. This can interfere with ovulation causing infrequent periods and, sometimes, difficulty in getting pregnant.

Metformin decreases release of glucose into the circulation by the liver and so insulin levels go down. Metformin can restore ovulation and has been used to help women with PCOS get pregnant, though it is not yet a standard treatment and is not FDA approved for this use. However, it can be prescribed for this purpose.

Metformin is a good idea for many women with PCOS but not all. This depends on how much insulin resistance is involved. As to infertility treatment, it is establishing a place for itself but choice between different possible treatments is highly individual. You need to work this out with a doctor you have consulted who knows your circumstances.
Hope this is helpful.

Geoffrey Redmond, MD

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