Metformin
Metformin (Glucophage) is a pharmaceutical drug often prescribed for diabetes and for women with PCOS (Polycystic Ovarian Syndrome). It is an insulin-sensitizing biguanide commonly used to treat elevated blood glucose levels in people with Type 2 Diabetes. Metformin is used as an off-label prescription for PCOS. This means that it was originally used only for individuals with Type 2 Diabetes but is now prescribed for PCOS patients because it has similar actions in both groups.
Metformin – Side Effects
Many women prescribed Metformin must discontinue its use due to the gastrointestinal side effects. The most commonly reported adverse effects include diarrhea, gas and bloating, abdominal discomfort, nausea, and vomiting (1, 6). Another consideration of Metformin therapy is its effect on B12 absorption. Ten - 30% of people receiving long term Metformin therapy develop B12 malabsorption, which could potentially lead to anemia.
It has also been shown that treatment with Metformin may increase homocysteine levels (amino acids found in the blood), which is a risk factor for atherosclerosis or fatty deposits in blood vessels (7).
The contraindications in using Metformin include liver failure, alcoholism, compromised renal function, hypoxic conditions and moderate to severe infections. These conditions predispose women to having lactic acidosis, which is a life-threatening complication and carries a mortality rate of 30% - 50% (1).
(1) Metformin: an update - Kirpichnikov D, McFarlane SI, Sowers JR. Ann Intern Med. 2002 Jul 2;137(1):25-33. Review.
(2) Metformin treatment of PCOS during adolescence and the reproductive period - La Marca A, Artensio AC, Stabile G, Volpe A. Eur J Obstet Gynecol Reprod Biol. 2005 Jul 1;121(1):3-7
(3) ) Metformin therapy decreases hyperandrogenism and hyperinsulinemia in women with polycystic ovary syndrome - Kolodziejczyk B, Duleba AJ, Spaczynski RZ, Pawelczyk L., Fertil Steril. 2000 Jun;73(6):1149-54 .
(4) Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome. A randomized, placebo- controlled, double-blind multicentre study - Tang T, Glanville J, Hayden CJ, White D, Barth JH, Balen AH., Hum Reprod. 2005 Sep 30
(5) Should patients with polycystic ovarian syndrome be treated with metformin? A note of cautious optimism - Homburg R., Hum Reprod. 2002 Apr;17(4):853-6. Review
(6) Metformin in polycystic ovary syndrome: systematic review and meta-analysis - Lord JM, Flight IH, Norman RJ., BMJ. 2003 Oct 25;327(7421):951-3. Review
(7) Homocysteine and steroids levels in metformin treated women with polycystic ovary syndrome - Vrbikova J, Bicikova M, Tallova J, Hill M, Starka L., Exp Clin Endocrinol Diabetes. 2002 Apr;110(2):74-6
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