Metformin

I decided to make this page because I keep getting emails asking about metformin, or "met" as I call it. I don't tend to reply to them because the answers are not short and it's a lot of work to reply to each one, but also because if you search met on this site you will get all my posts and pretty much get to read all about my experiences with it.

There is a lot I could say about met and because of that I will probably come back and edit this page periodically as I think of new things.

The information I provide about met is based on my own experiences. I'm not qualified to give any advice to anyone about what they should put in their body, but since you want to know, here's my take on it. Also, my experiences are based on using it to treat PCOS and insulin resistance (not diabetes).

Oh, and I'm totally biased because I have had a really great experience with met. I actually started feeling physically better and had more energy from the first couple of weeks that I took met. It's been one of the best discoveries in my life. It think it's a great drug when used appropriately.

Ok, here are some common questions people ask me about met

How do you know if you need met?

I am a 'text book' case of PCOS (fat, oily, acne, no periods, etc) so when I finally got to a qualified REPRODUCTIVE ENDOCRINOLOGIST he took one look at me and pretty much knew I should give met a try, but just to be sure he made me take a 2 hour glucose tolerance test. I had taken these before but my other drs had only had my blood sugar levels measured. It is critical that your insulin levels are measured too. I passed on my sugars just fine, but I flunked my insulin levels, badly.

Reproductive Endocrinologist? What about my Gynocologist or regular Endocrinologist?

I'm sure that your Gyn and Endo are good people, but they very well may not be the best people to help you with your PCOS. PCOS is a syndrome effecting several of your body's organ systems. I was lucky enough to have a gynecologist that recoginized PCOS when I was a teen, but he didn't do a damn thing to help me. I went to an Endo when I was in college and even though he should have been trained to deal with this he offered me no help either. Although he was diligent about checking my thyroid levels and and ruling out other conditions that have similar symptoms to PCOS. Even if you are not ready to have a baby, I would still encourage you to look for and set up an appointment with a board certified Reproductive Endocrinologist (RE) to manage problems related to PCOS. There are bad REs too. If you meet someone that just tells you that you are fat and need to loose weight, I'd find another RE (although chances are that you do need to loose weight that losing weight would help you, this has been well studied and found to be very effective, but it's not always as simple as that).

How much met did/do you take?

The biggest thing when you begin taking met is to build up the dosing. Met can have some nasty GI side effects... diarrhea (cha cha cha), gas, etc. Here are the exact instructions from my very first script (yes, I still have the pill bottle):
Take 1 tab by mouth once daily for 7-10 days, then take 1 tab twice daily for 7-10 days then begin 750mg rx
Then I started a script taking 750mg Extended Release (ER) tablets twice daily. I take one at lunch and one before I go to bed. This works for me.

How long did it take for the met to work? (i.e. get pregnant)

My RE warned me that met usually take 3-6 months to work. And his nurse told me that he normally doesn't let his patients start on other fertility meds until they've been taking met for several months, but he let me start right away. Your dr may want to hold off for this reason and, if you are paying out of pocket for treatments, it might make sense financially to hold off spending additional money on treatments until you've given the met a chance to work. A lot of women get pregnant on met alone. In fact, I have met diabetic women that thought they couldn't get pregnant and had no desire to get pregnant and were not trying and accidentally got pregnant after they started on met.

If you look under the "What's Going On..." on the side of the page you will see that I took my first met dose in October of 2008 and got pregnant in May of 2009... so about 8 months. I had my first ovulation in February of 2009, so it took my body roughly 4 months to start 'working'. As it turns out, I had the additional issue of MTHFR so if I would have been treating for that I might have gotten pregnant even earlier.

What's MTHFR?

You can search that one on your own but it's short for mother fucker methylenetetrahydrofolate reductase and it's a genetic disease that inhibits folic acid absorption and can lead to miscarriage and birth defects. It's relatively common and there are different degrees of it. I have a mild to moderate form of it and was able to treat it with folic acid and baby aspirin. It's not related to PCOS in any way as far as I know and I'm just kinda throwing this in there, but it brings up another point that I'd like to make about PCOS: Inflammation

What about PCOS and Inflammation?

PCOS is still kinda baffling to doctors and researchers. Even though it's very common, it doesn't get a lot of attention. I don't know if anyone will ever be able to pin point exactly what causes PCOS (there are certainly genetic and environmental factor) or find a true cure for it, but there are certainly different theories out there on causes and treatments.

Some drs/researchers like to point the finger at 'inflammation'. I guess inflammation can mean a lot of things in a general sense, but I think there is a enough evidence out there to say that having a lot of 'inflammation' is bad for you. And some drs/researchers think a good way to control PCOS is to reduce inflammation.

I'm not terrible informed on 'inflammation' but diet, exercise, supplements (like omega-3s), and NSAIDs all have an impact on this. I eat 2 tablespoons of ground flaxseed every day because it's supposed to help with inflammation (and I think it does, as well as other things). I also started taking Baby Aspirin the cycle I got pregnant. This probably helped because I had the MTHFR (see above) but this may have helped with the PCOS some too. It's NOT recommend that you take NSAIDs (ibuprofen, Alieve, regular strength aspirin) while TTC (they can inhibit ovulation because they are TOO anti-inflammatory), but most drs will not have any problem with you taking a baby aspirin unless there are other indications against you taking it. Talk to your dr before starting this therapy. It also makes a difference when you are pregnant... some anesthesiologists will not give epidurals if you've recently taken a dose. Your mileage may vary so check your hospital's policy on baby aspirin.

What about taking Metformin when you are pregnant?

I think it's just fine. So did my maternal-fetal-medicine specialist. In fact my MFM recommends that his patients stay on met when they get pregnant. Although there are risks and benefits to taking any medication while pregnant, for me the benefits seemed to out weight the risks. I fear that drs that advise you to stop are probably not current on their research on this topic and shouldn't be making this recommendation without researching because it can make a difference during pregnancy. I have written a long post here if you want to read more.

I can tell you that I have had a healthy pregnancy. I did not develop gestational diabetes. I gave birth to a healthy 8lb 3.5oz boy that had no blood sugar problems. And today he's a very tall and 'sturdy' toddler that has met all his developmental milestones appropriately. He's scored in the highest range in every category of the Ages and Stages (I think that's what it was called if that means anything to anyone) assessment. I have no reason to think that met caused any negative health or developmental problems for him. I'm very proud of him :)

What about taking Metformin while breastfeeding?

I never quit taking met and breastfed my son. In fact, he's about to turn 2 and I still breastfeed him. I know there are plenty of research papers out there studying metformin in breastmilk. A very small amount does get in the milk, but it seems to be a 'safe' level according to the research I've seen. Again, there are risks to taking medicines while breastfeeding. Breastfeeding has many positive benefits for the baby and mother and I think they far outweigh any negative risks of what met might get in the milk.

Does metformin help you loose weight?

Um... probably. All I can offer here is my own experience, but I have always been overweight or obese. Dieting never seemed to work for me at all. If I wanted to lose weight I had to go sweat it out in the gym... and not just walking a track, lots and lots of weight training and cardio. It works, but it's tough. Very shortly after I started taking met I dieted and probably dropped 20lbs in about 2 months. Food seemed to impact me very differently after I started taking met. Before I was a bottomless pit and after taking met it seemed to make more of a difference what I put in my mouth. When I dieted I actually lost weight for the first time in my life. Truly, the weight did seem to melt off. Then I got pregnant and gained about 80 lbs (gulp).

I'm holding on to a lot more of that pregnancy weight at 2 years out than I would like to be and it ain't coming off easily like it did when I started the met. I think the fact that I'm still breastfeeding may not be helping (contrary to what people say about breastfeeding helping to loose weight, it can also cause you to hold on to weight), but mostly it's because I've been lazy and over-indulging.

So I do think met can help you if your are also willing to help yourself, but probably only so much. It's not a magic bullet.

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I'll come back and add to this as I think of new questions. There is helpful Q and A about PCOS on the INCIID that I would encourage women with PCOS to check out as well.