Metformin for PCOs: Understanding Benefits And Potential Risks

Polycystic Ovary Syndrome, also called PCOS, affects a wide range of women. It’s a hormonal health issue that can lead to weight gain, missed periods, acne, or too much hair on the face. One cause of PCOS is insulin resistance, where your body doesn’t use insulin the way it should.

That’s where metformin often comes in. Though mainly a medicine for type 2 diabetes, doctors also use it to treat PCOS in women with high insulin levels.

This guide takes you through how metformin works for PCOS, what results to expect, what side effects to watch, and what other options exist if metformin isn’t the right choice for you.

What Is Metformin and How Does It Work?

Metformin belongs to a group of drugs called biguanides. It helps lower the sugar your liver makes and cuts down the sugar absorbed from food. It also makes the cells in your body more open to insulin.

The U.S. Food and Drug Administration or FDA has officially approved metformin to treat type 2 diabetes. Doctors also prescribe it for PCOS, based on how it helps control blood sugar and balance hormones.

It works in three ways:

• Stops the liver from making too much glucose

• Helps the muscles absorb glucose better

• Reduces how much glucose your body takes in from the food you eat

Because of how it works, metformin improves the body’s use of insulin. This makes it helpful not just for people with diabetes, but also for those with PCOS who deal with high insulin and irregular periods.

How Metformin Helps in PCOS

PCOS messes with your hormones. Your body may make more male hormones (androgens) than needed. This causes symptoms like irregular cycles, acne, or hair growth on the face.

One trigger for this is high insulin. If your body resists insulin, it will try to make more of it. The extra insulin then boosts androgens.

This is where metformin plays a role. It reduces insulin resistance, which helps balance hormone levels. Once that balance is back, your cycle may get more regular. Ovulation becomes more likely.

Doctors often recommend metformin for women with a high BMI. But new research shows that even non-obese women with PCOS benefit from it, especially when it comes to ovulation.

It can help improve your chances of conceiving. Many women with PCOS who took metformin saw their cycles return or improved egg release over time.

Other Health Effects of Metformin in PCOS

Metformin does more than control blood sugar or fix your cycle. It may also:

• Lower testosterone – This helps with oily skin, hair fall, and facial hair.

• Reduce acne – By bringing hormones into check.

• Cut diabetes risk – PCOS can lead to diabetes if left unchecked. Metformin reduces that chance.

• Help with weight loss – Not a weight-loss drug, but it may help shed some extra kilos.

• Lower IVF risks – Some women with PCOS face a rare risk called ovarian hyperstimulation when on fertility drugs. Metformin may lower this risk.

Is Metformin Safe for Long-Term PCOS Use?

Doctors often start with a low dose to let your body adjust. Over time, the dose may go up if your body handles it well.

Most women use metformin for months or even years, based on how their body responds. Some stop once their periods become normal or if they get pregnant.

You should not stop metformin on your own. Talk to your doctor first, especially if it was helping manage blood sugar or regulate cycles.

Common Side Effects of Metformin

Your body may need a few days or weeks to get used to this drug. During this time, you might feel some mild side effects like:

• Loose stools – Happen as the drug changes how your gut handles glucose.

• Stomach cramps or bloating – Often improves if you take it with food.

• Mild nausea – Eating before your dose may help.

• Headache – Usually short-term and mild.

• Metallic taste in the mouth – Happens in some, but not all. Goes away on its own.

Most of these go away once your body adjusts. Doctors usually start with a small dose and slowly increase it to reduce these issues.

Less Common But Serious Risks

Though rare, metformin can cause more serious effects in some people. You need to know what to watch for:

• Low blood sugar – More likely if you take other sugar-lowering medications, skip meals, or drink too much.

• Vitamin B12 shortage – Long-term use can lower B12 levels, which may lead to fatigue, cold hands, or even nerve issues.

• Anemia risk – Happens if B12 stays low. Your doctor may check your levels from time to time.

• Lactic acidosis – This is very rare but serious. It means lactic acid builds up in the blood. Signs include muscle pain, weakness, fast breathing, or feeling cold. This is a medical emergency.

If you feel weak, dizzy, or sick while on metformin, don’t wait. Call your doctor or go to the ER.

Can Metformin Help You Lose Weight with PCOS?

Yes, but only to a small extent. Metformin is not a fat burner, but it helps balance insulin, which in turn helps your body store less fat.

Some women find that they lose weight slowly while on it. Others don’t notice much change unless they also change their diet and stay active.

Doctors may suggest adding simple lifestyle changes like walking, home workouts, or switching to low-sugar meals to boost the effect.

How Long Does It Take to Work for PCOS?

Metformin doesn’t work overnight. Doctors usually start you off on a low dose to cut side effects. It might take a few weeks to build up to a full dose.

Once you reach a steady dose, you may see changes within 4 to 8 weeks. For some, cycles get regular faster. Others may need 3 months or more.

Each body is different, so don’t compare results with friends or others. Stick with the plan your doctor gave you.

What Happens If You Stop Taking Metformin?

If you stop it without advice, your insulin and sugar levels may go back up. This can bring back missed periods, skin issues, or weight gain.

Always talk to your doctor before stopping. If you want to stop, they might lower the dose slowly or offer other options.

Some women don’t need it long-term. Others do. Your doctor will decide what works best for your body.

Alternatives to Metformin for PCOS

If metformin doesn’t suit you, doctors may suggest other drugs. These may help with ovulation, hair growth, or blood sugar:

• Letrozole – Often used in fertility cases. Helps release eggs in women who don’t ovulate.

• Gonadotropins – Hormone shots used in IVF or other fertility plans.

• Eflornithine – Cream used for unwanted hair.

• Sulfonylureas – Boost insulin but carry the risk of low sugar.

• Meglitinides – Help release insulin after meals.

• Thiazolidinediones – Improve insulin action but may have side effects like water retention or weight gain.

Doctors choose based on your age, weight, cycle, and symptoms. Don’t self-medicate.

Final Thoughts

Metformin for PCOS can help manage hormone balance, blood sugar, weight, and fertility. It is often part of a larger plan that may include diet changes and mild exercise.

The drug is safe for most but comes with mild and rare serious side effects. Doctors often keep a close eye through tests.

Never start or stop metformin on your own. Let your doctor guide your journey. Each case of PCOS is different, so treatment should be based on what your body needs.