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Polycystic Ovarian Syndrome

PCOS – polycystic ovarian syndrome.

Polycystic ovary syndrome (PCOS) is an endocrine system disorder. Symptoms may include enlarged ovaries that contain small collections of fluid — called follicles, infrequent or prolonged menstrual periods, excess hair growth, acne, and obesity. In adolescent girls, infrequent or absent menstruation could be a symptom.

The exact cause of polycystic ovary syndrome remains unknown. However, early diagnosis and treatment along with weight loss may reduce the risk of long-term complications, such as type 2 diabetes and heart disease.

PCOS is not just one disorder. Every patient has some combination of factors to “get” the diagnosis, but it is rare that PCOS is the exact same for any two patients.

The diagnosis can be made based on medical conditions, like diabetes and high blood pressure. Sometimes the diagnosis is based on blood tests, like FSH (follicle-stimulating hormone) and LH (luteinizing hormone), or insulin levels, or testosterone levels. Sometimes it is based on being overweight, with extra hair growth, and having irregular periods. PCOS can even be diagnosed using ultrasound.

When discussing fertility issues, PCOS is a version of irregular periods and unpredictable ovulation. There are three medicines in two categories used to treat the ovulation problem of PCOS. One medicine, metformin is specific to PCOS. The other two pills, clomiphene and letrozole, are used to treat all versions of ovulation dysfunction. Published studies found metformin LESS effective than the other two, for fixing ovulation in patients with PCOS.

Metformin, brand name Glucophage, is used to treat many aspects of PCOS, including the ovulation problem. We are not certain Why metformin helps fix ovulation in PCOS, but it does. All medications have effects and side effects, including metformin. The effect is return of ovulation. The side effects can include stomach ache, diarrhea, and general soreness. Metformin must be taken every day, even three times every day, to do its job.

Newer research studies have shown clomiphene and letrozole to be MORE effective than metformin alone. The addition of metformin to clomiphene and letrozole does not increase pregnancy rates. The bottom line: while metformin may be “good” for PCOS, it is not a useful fertility medicine.  Metformin is not worth taking, in women trying to get pregnant.

Why is metformin still prescribed in PCOS for help getting pregnant?

Metformin remains in use for a number of reasons. First, it is easier to use than clomiphene and letrozole. Metformin it taken every day, and the other meds must be prescribed for a very specific five days in the cycle. Next, older studies Overestimated the efficacy of metformin. As a result, we got used to using metformin. Newer studies do NOT find metformin so effective. There may be other reasons, too. Finally, while metformin is not so helpful in getting pregnant, it is a good treatment for PCOS.

But do I really have PCOS?

Here, the focus is on PCOS and fertility. This discussion does NOT address PCOS and long term health issues. Metformin has a role in the non-fertility treatment of PCOS. But for fertility and pregnancy, there is little or no benefit to using this medication.