I was just prescribed metformin 800mg once a day to treat PCOS. I was wandering if you could tell me exactly what this medicine is supposed to accomplish? Does it help with hirsutism? Weight loss? What?

B.R.

Metformin (Glucophage) is increasingly being used to address the symptoms associated with PCOS (polycystic ovary syndrome), a disorder marked by a wide range of symptoms that may include menstrual irregularity, infertility, obesity, hirsutism (excess body hair) and/or acne. Most studies have shown metformin to be useful at lowering the elevated male hormone levels involved in PCOS. This induces weight loss, normalizes blood lipids and restores regular menstrual cycles in up to 85 percent of the women using it for six months. However, it does not work for all women. About 20-30 percent of women are unable to tolerate the medication due to upset stomach, nausea or diarrhea. Of those who do continue to take the medication, along with modifying diet and beginning a mild exercise program, about half can see fairly dramatic results in one or all of their PCOS symptoms. Unfortunately, others find little or no benefit to its use.

At the dose you are using, the metformin will most likely have no effect on your symptoms. It is been found effective at doses between 1,500mg to 2,550mg daily. Most of my patients use 850mg twice daily. Your physician may be starting you at a lower dose to reduce the risk of side effects, with the intention of moving you to a higher dose over time.

Metformin is FDA-approved for the treatment of Type II diabetes. Although there are no FDA trials looking at safety and effectiveness issues surrounding the use of metformin to treat PCOS, a growing body of medical literature has addressed both these issues to the satisfaction of many physicians. Even so, too many physicians have not taken the time to review this literature, or they have little experience using metformin and therefore do not recommend its use for PCOS. I find this unfortunate. Although there are alternative medications to address many PCOS concerns, these alternatives may result in polypharmacy (taking multiple medications), unnecessary expense (metformin is much cheaper than injectable fertility medications) and potentially avoidable side effects (multiple births).