Glucophage
(metformin)
Polycystic ovarian syndrome (PCOS) is a common cause
of infertility in women. It is characterized by anovulation
(lack of ovulation) or oligoovulation (irregular ovulation),
ovaries containing numerous cysts, insulin resistance
and symptoms of elevated androgens (male hormones).
These symptoms can include excess facial hair growth,
thinning of head hair, elevated cholesterol levels,
and difficulty loosing weight.
PCOS
patients are usually hyperinsulinemic, which means they
have elevated insulin levels. Insulin is secreted by
the pancreas and normally causes a decrease in glucose
levels. In the PCOS patient, for a given amount of insulin
the reduction in glucose levels is less than in a normal
patient. The body produces more insulin (hyperinsulenemia)
to account for this reduced response. The high levels
of insulin cause an overproduction of androgens and
increase the long-term risks of coronary and vascular
diseases. Elevated levels of androgens also interfere
with normal ovulation in PCOS patients.
Glucophage
(metformin) is currently being used successfully to
induce ovulation in PCOS patients. Oftentimes metformin
is used by reproductive specialists as a "first
line" therapy or in patients who fail Clomid therapy.
Metformin is sometimes used in combination with either
Clomid or FSH. PCOS patients often have an exaggerated
response to FSH medications and must always be monitored
by a reproductive endocrinologist.
Metformin
sensitizes the cells to insulin thus lowering the body's
production of insulin and consequently reducing androgen
production. Once androgen production has been normalized,
ovulation often resumes. Metformin is dosed at 850 mg
two times per day. Clomid or FSH may be added if ovulation
is not established. The major side effects of metformin
are stomach aches and loose stools.
Many
specialists prescribe metformin for long term maintenance
in PCOS patients. Normalization of insulin levels over
time will reduce the risk of medical conditions such
as cardiovascular disease.
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