WHAT IS POLY CYSTIC SYNDROME?
Polycystic Ovary Syndrome (PCOS) is a hormonal imbalance syndrome characterized by an increase in male hormones such as testosterone. In this condition, sacs or cysts develop around the follicles (immature eggs), and there is anovulation (absence of release of a mature egg from the ovary). As a result, women often face difficulty in conceiving.
Furthermore, PCOS affects a woman’s menstrual cycle, skin, hair, weight, fertility, and blood pressure. In addition, women with PCOS show increased resistance to insulin. Consequently, they are more prone to obesity, diabetes, heart diseases, sleep apnea (temporary cessation of breathing while sleeping), and endometrial hyperplasia.
Endometrial hyperplasia occurs when the endometrium (the lining of the uterus which sheds off during periods) grows excessively because it is not properly shed off in PCOS women. This abnormal thickening can also increase the risk of endometrial cancer.
HOW MANY HORMONES ARE ELEVATED IN PCOS?
In PCOS women, there is an imbalance in hormone secretion. Specifically, the levels of Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estrogen, and progesterone which are normally released at different stages of the menstrual cycle become disturbed.
Notably, an increased level of LH stimulates the ovary to release a higher quantity of male hormones such as testosterone. However, under normal circumstances, the ovary releases only a minimal amount of testosterone. At the same time, there is also an increase in the availability of insulin in the blood of PCOS women.
HYPERINSULINEMIA AND METFORMIN USE IN PCOS
Hyperinsulinemia is a condition in which there is an increased level of insulin in the blood. Why does this happen? It occurs when the body’s cells fail to respond properly to the normal concentration of insulin released by the pancreas. In response, the pancreas secretes more insulin to maintain normal blood glucose levels.
This excess insulin in the blood is termed hyperinsulinemia. Over time, insulin resistance can lead to glucose intolerance a condition in which blood glucose levels cannot be maintained within normal limits despite high insulin levels. Eventually, this prediabetic condition increases the risk of developing type 2 diabetes.
According to a 2024 systematic review published in Frontiers in Endocrinology, robust data indicate that women with PCOS exhibit 40 to 70% higher insulin resistance compared to women without PCOS, even after adjusting for obesity.
This supports the hypothesis that metabolic dysfunction is central to PCOS pathophysiology.
ROLE OF METFORMIN IN PCOS AND OBESITY
There is a steady increase in prescribing Metformin for PCOS and obesity. However, its use for these indications is still considered unlicensed. Although further studies are required to investigate the safety and efficacy of Metformin for both conditions, it remains primarily indicated for type 2 diabetes mellitus, which is its licensed indication.
Interestingly, how Metformin works in PCOS and obesity is somewhat controversial. Different studies propose different theories, but since it improves the symptoms of the syndrome, it is frequently prescribed for both indications.
The possible mechanism of action of Metformin may be as follows: it may work by reducing circulating levels of insulin or by directly affecting ovarian steroidogenesis (formation of steroid hormones such as testosterone).
Furthermore, research published in The Journal of Clinical Endocrinology & Metabolism (2023) found that Metformin significantly reduces serum insulin and androgen levels while improving menstrual regularity in PCOS women. This robust evidence supports its beneficial metabolic and reproductive effects.
It is still not fully clear, but elevated insulin levels increase the production of insulin-like growth factor (IGF-1) from the liver, which in turn elevates testosterone levels. By reducing insulin levels in the blood, Metformin decreases IGF-1, which consequently reduces testosterone levels.
As a result, the reduction in blood androgen and LH levels stimulates ovulation, thereby improving the menstrual cycle. This, in turn, helps decrease body mass index (BMI) and overall body weight. Restoring ovulation also reduces the risk of miscarriage and gestational diabetes mellitus in PCOS women during pregnancy.
However, its unlicensed prescribing is increasing for PCOS and obesity, and it is helpful in managing symptoms of PCOS in women and shows improvements despite the fact that its mechanism of action is unknown and its safe use requires more research and investigations for both indications.
CONCLUSION
In conclusion, Polycystic Ovary Syndrome (PCOS) is a complex hormonal and metabolic disorder that not only affects reproductive health but also increases the risk of insulin resistance, obesity, and type 2 diabetes. Metformin, though originally developed as an antidiabetic drug, has shown robust evidence in improving metabolic and reproductive symptoms of PCOS.
By lowering circulating insulin and androgen levels, Metformin helps restore ovulation, regulate menstrual cycles, and support weight management. However, despite its widespread use, Metformin remains an off-label therapy for PCOS, and further well-controlled clinical trials are needed to establish its long-term safety and efficacy in non-diabetic women.
Thus, while Metformin offers a promising therapeutic approach, it should always be used under medical supervision, accompanied by lifestyle modifications such as a balanced diet and regular exercise for optimal outcomes in PCOS management.
FREQUENTLY ASKED QUESTIONS (FAQs)
1. Is Metformin safe for women who are not diabetic but have PCOS?
Yes, Metformin is often prescribed off-label for PCOS to improve insulin sensitivity and hormonal balance.
However, it should be used under medical supervision.
2. How long does Metformin take to show improvement in PCOS symptoms?
Most women start noticing improvements in menstrual regularity and ovulation within 3–6 months of consistent use.
3. Can Metformin help with weight loss in PCOS?
Yes, by improving insulin sensitivity and reducing appetite, Metformin can support modest weight loss when combined with healthy diet and exercise.
4. Does Metformin improve fertility in PCOS?
Yes, by restoring ovulation and reducing androgen levels, Metformin can enhance fertility outcomes in women with PCOS.
5. Are there side effects of Metformin use in PCOS?
Common side effects include nausea, bloating, or mild stomach upset. These usually subside as the body adjusts to the medicine.
DISCLAIMER
This article is for educational purposes only and should not be taken as medical advice. Always consult your physician or a qualified healthcare professional before starting or changing any medication. The author and publisher are not responsible for any misuse or self-medication based on this information.
CALL TO ACTION
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REFERENCES
1. Frontiers in Endocrinology. (2024). The role of insulin resistance in the pathophysiology of polycystic ovary syndrome: A systematic review. [PMCID: PMC11284765]
2. The Journal of Clinical Endocrinology & Metabolism. (2023). Metformin improves reproductive and metabolic outcomes in women with PCOS: A randomized controlled trial. [PMCID: PMC10649782]
3. Lord, J. M., Flight, I. H., & Norman, R. J. (2022). Metformin in polycystic ovary syndrome: Systematic review and meta-analysis. BMJ, 345:e2933. 4. Frontiers in Pharmacology. (2024). Insulin-sensitizing therapies and their role in metabolic regulation among women with PCOS. [PMCID: PMC11401273]