“Is Metformin a lifelong medicine?”

Yes, but if you conceive then it should be stopped if you have no problems with the sugar

No once the hormonal balance is corrected you may stop it

No, not unless you also begin to develop pre-diabetes later in your life.

Not necessarily. Metformin helps in 50% of PCOS patients to resume their menstrual cycles. It helps to improve insulin sensitivity, and also reduces serum-free testosterone, and increase HDL cholesterol. Once the patient's cycles have become regular and their weight is under control, there may be no need to continue with the metformin.

Not really. Normally, people take it for 6 months to one year and also, in the meantime, start doing some exercises and eat a healthy diet.

Not necessarily

Hello,

Great question to ask. Most patients whom are started on metformin are given it to control blood sugar levels in diabetes and also in patients with polycystic ovarian syndrome (PCOS). Determining if metformin is needed for your entire life is difficult to answer. Often times, patients are able to lose weight and eat a healthy diabetic diet and keep blood sugars in range without using any medications. However, the likelihood of needing metformin for a long period of time is quite common.

Richard T. Burke, MD

The better question to ask is ‘Is PCOS a lifetime diagnosis?’ If PCOS is the reason for the elevated fasting glucose but normal insulin level (called hyperglycemia) or elevated fasting glucose plus elevated insulin (called insulin resistance) or Type 2 diabetes which is a persistent elevated fasting glucose plus elevated insulin, then controlling the hormone imbalance of PCOS may actually help with fasting glucose and insulin levels. PCOS or Polycystic Ovary Syndrome is by definition a male/female hormone imbalance; your ovary produces a higher percentage of Total and Free Testosterone than it should which can suppress normal production of your 2 female hormone levels of Estradiol and Progesterone. This hormone imbalance needs to be brought back into balance which is the first step. If you cannot drop the Testosterone levels back to 15th% of normal range which is considered age appropriate, then your other hormones in your body try to come to the rescue and help out; this includes your insulin level. A fasting insulin level for women is not a well recognized value; it is only listed as a normal lab range for men. The lab range is <24.9 but I recommend the female range of <15; however, optimal levels for Alzheimer’s prevention actually lists <4.5!! (reference: End of Alzheimer’s by Dr. Dale Bredesen). In other words, sugar is the enemy. So addressing lifestyle issues such as cutting white sugar and man-made carbohydrates from your diet is an important step toward addressing your fasting glucose and insulin levels. Some patients with PCOS will have a drop in glucose and insulin occur with dropping their Testosterone levels; however, some patients have a more moderate or severe PCOS that require Metformin to help them even if they are successful in dropping their Testosterone levels, it just takes following the bloodwork to know how your body is responding. So once you start on Metformin, you may also bring back normal periods and may even ovulate on a more regular basis which is important if you want to get pregnant.

So ask your doctor to check your bloodwork: you need day 21 of your cycle bloodwork if you wish to tie your Estradiol, Progesterone, Total Testosterone and Free Testosterone levels to your fasting glucose and insulin levels (4hr fasting). Only by knowing where your levels are can you know if your Metformin is helping not only your blood sugar but also your female cycles.

And remember, if you have an elevated glucose and require Metformin, you are at increased risk for diabetes in pregnancy that may even require insulin and you are at increased risk for type 2 diabetes later in life. So learn as much as you can about how your body responds to Metformin now, how it impacts your female/male hormone levels now so you can help protect your health in the future.

Usually not. Sometimes after pregnancy, ovarian function returns to normal. Certainly after menopause, PCOS is no longer an issue.

Not necessarily. Many factors influence the symptoms of PCOS. You should discuss your options including ovulation induction medication or oral contraceptives with your gynecologist. Treatment can vary depending on your symptoms and desire for conception.