Metformin (glucophage) for PCOS
Metformin (Glucophage) belongs to a class of drugs known as insulin sensitizing agents. Metformin is used in diabetic patients who are typically hyperinsulinemic, which means that the body produces excess insulin to compensate for the cells reduced insulin 
sensitivity.
Metformin is used in these patients to increase the pancreatic cells sensitivity to insulin, thus lowering the levels of circulating insulin.
Metformin is now being used to restore normal ovulation in PCOS patients. Polycystic ovarian
syndrome (PCOS) is a common cause of infertility
in women and is characterized by excess production of
androgens (male hormones), hyperinsulinemia, irregular
or no ovulation, ovaries covered with numerous small cysts,
“hairy body,” obesity, (PCOS patients may
be thin), increased risk of miscarriage,
and other symptoms.
Most of the symptoms of PCOS are caused by excess androgen production. Abnormally elevated
insulin levels also increase the production of LH by the
pituitary gland, which further increases androgen levels.
Metformin, and other drugs in this class, sensitize the cells to insulin causing them
to respond normally to a given amount of insulin and ultimately lowering male hormone (androgen) levels. Ovulation
will often resume when the circulating levels of androgens are reduced.
Metformin is also being used as "maintanace therapy" to prevent the potential long term health consequences associated with chronically elevated insulin levels. These health risks include cardiovascular disease, diabetes, and other conditions. For this reason, some women will continue on metformin after their fertility issues have been resolved.
Metformin is usually administered at 500
mg three times daily. It may be combined with
Clomid or FSH
if ovulation does not occur. The most common side effects
of Metformin are nausea and diarrhea. Furthermore,
it is often used 2-3 months prior to Clomid or Femara
to increase the ability to respond to the fertility drugs.
