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Discussion Starter · #1 ·
Hi guys

I found this on the net last night. I've pasted it from a website for Welsh NHS doctors. From my limited understanding of medical terms (ie very limited!) it seems to be telling me that metformin DOES promote ovulation (yippee!) but there is no proven link to weight loss (not so good!) If you want to find the site I did a google search with the terms "metformin" and "mennorhagia" and "PCOS"

Hope it helps you convince your GP to describe it. My GP in Swansea prescribed it to me about 3 years. Unfortunately when I moved to England my GP was very disparaging and worried me to death my telling me it was not licensed! Luckily for me I was able to change my GP to one who is very supportive and I managed to get another prescription and a referral to a consultant. All this was before I mentioned that we were TTC so I consider myself very lucky indeed....

Question:
What is the current thinking on treatment of Polycystic Ovarian Disease (PCOD) with metformin?

Answer:

A Cochrane systematic review amended in January 2003 has studied the use of insulin-sensitising drugs, including metformin, troglitazone, rosiglitazone, pioglitazone and d-chiro-inositol, for PCOD.

"Meta-analysis showed that metformin is effective in achieving ovulation in women with PCOS with odds ratios of 3.88 (CI 2.25 to 6.69) for metformin versus placebo and 4.41 (CI 2.37 to 8.22) for metformin and clomifene versus clomifene alone. An analysis of pregnancy rates suggests a significant treatment effect for metformin and clomifene (OR 4.40, CI 1.96 to 9.85). Metformin has a significant effect in reducing fasting insulin levels (WMD -5.37, CI -8.11 to -2.63), blood pressure and low-density lipoprotein cholesterol (LDL). There was no evidence of effect on body mass index or waist:hip ratio. Metformin was associated with a significantly higher incidence of nausea, vomiting and other gastrointestinal disturbance, but no serious adverse effects were reported.

Metformin is an effective treatment for anovulation in women with PCOS. Its choice as a first line agent seems justified, and there is some evidence of benefit on parameters of the metabolic syndrome. Ovulation rates are higher when combined with clomifene (76% versus 46% when used alone), but there is no evidence to indicate whether there is an increased multiple pregnancy rate with this combination. There is no data regarding its safety in long-term use in young women. It should be used as an adjuvant to general lifestyle improvements, and not as a replacement for increased exercise and improved diet". (1)

1. Lord JM, Flight IHK, Norman RJ. Insulin-sensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone and d-chiro-inositol) for polycystic ovary syndrome. (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

Reference: http://www.attract.wales.nhs.uk/question_answers.cfm?question_id=1394
 

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Hi Arabella

I took metformin with my 2nd cycle. we only got 4 eggs but i got pregnant and had a little boy. With my 3rd cycle i took metformin for longer and we ended up with 24 eggs, 15 of which fertilised and 9 were very good grade 1 embryos. I have never had enough to freeze before. Both times i stopped the metformin at EC but after m/c at 5 weeks last time my consultant has told me to continue to take it till 12 weeks as it has been proven to help with m/c.

Thanks for this.

love Kim x x x
 

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Hi Arabella

I just posted a thread similar to this. The full text of the article which was in the British Medical journal is here;

Click here ot read

I even took this to my GP but nooooooo, she wouldn't be persuaded as it's still awaiting license as you say. She was actually quite within their rights as should there be a problem then she may be on a sticky wicket. My Consultant had to write to her to say it was on his say so so he did my first three month prescription and asked that she continue it.

Anyone struggling could also use the NICE guidance. The other person my Prof recommends to read is a chap in the states who was one of the big advocates of metformin and that's Glueck. Failing that would suggest a visit to the hossy for a letter to the GP!

Yours a very grateful metformin fan! XX
 

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I'm wondering if there's any consensus on 'how many metformin to take a day' and 'whether it's as effective in women with normal BMI as those overweight'.

My BMI's normal, but I have PCOS and it's been 8 wks since my last period. I've been on 3 x 500mg / day of metformin for a few wks now and was wondering about taking a fourth. My GP is very supportive and I could easily suggest this to her. I'm supposed to be starting clomiphene on my next cycle - whenever it decides to appear. (When I was younger I didn't like their unattractive appearance, now I welcome them with open arms!)
 

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Discussion Starter · #5 ·
Hello Rowena

I'd not realised that people were on different doses of metformin.  I also take 3 x 500mg per day, and have been for one month now.  What do you anticipate adding an extra tablet will do for you?

I've certainly had a shorter cycle although I guess it's too early to tell whether this is due to the metformin or is just a quirk - previously 2 cycles have been 40 odd days, before then fortnightly!  This one was 25 days but I don't think I ovulated.

I think I've lost weight but I've been following the low-fat and low-carb thing too, although I must admit I have been very liberal with the chocolate in the last month.  My excuse is that I was deprived of it for a year while I dieted for my wedding and as this took place last month I am now able to eat it again!
 

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Hi Arabella,
My previous consultant told me he tried up to 6 x 500mg metformin per day before he progressed to clomiphene. Presumably he had experience of this being worthwhile. My current consultant tries clomiphene then adds metformin if necessary. Another consultant advised me that in his opinion it wouldn't help to increase more than 2 x 500mg / day. Confusing eh!!? ???
What do I think as a result? Well, here I sit waiting for a period which typically come 2 - 6 mths apart (despite 4 mths trial with clomiphene - 1 of which worked) and feel the need to do something so I can try clomiphene again before I go nutty! I've lost the recommended weight (BMI now 23), I'm swimming 3 x per wk, don't smoke, drink little alcohol, support my partner with his lifestyle changes and still we wait. IVF isn't available on the NHS here and I've been under fertility care for 18 mths ttc >3yrs. Although I speak with my Dr re any treatment changes, I feel it necessary to keep on top of the job too and suggest things. After all, it is up to us what we are willing to put our bodies through. It would be good to hear from anyone with experience of whether more that 3 - 4 x 500mg metformin is helpful especially in a person with normal BMI. Hope this answers your question Arabella.
Lots of Love  :-* xx.
 

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Morning

It seems there's a lot of inconsistency re prescribing habits re metformin and pcos.  I think this will probably become more uniform if the drug gets licensed for use in pcos.  Certainly all the papers I've read have tended to concentrate the use of meformin in pcos patients with raised bmi.  I wonder if there's any merit in posting this in the voting room?  I'd be specific about dosage to include normal and raised bmi.  Would be interesting to see.  Personally I'd like to take a dosage higher than the 3 x 500mg to improve the efficacy, my DH tells me HE couldn't cope with the increased side effects so I guess it's sticking to three tablets for me!

Lolly X
 

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Discussion Starter · #8 ·
Hi Lollypop67 - what do you think your DH means by increased side-effects?  Has he noticed any?

I've been taking it for a month now and I feel like a cloud has been lifted from my brain.  I hope that doesn't sound too weird!  I'm sleeping better, I have more energy and I've even found the energy to go and exercise.  Perhaps I've been lucky.
 

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Hi Arabella

I'm in my fourth month of metformin and am a totally changed woman, love it, like you have so much more energy, there really are two nine o clocks in the day, show me the party! ::)  The downside to the metformin is that I have developed the loudest  ^evil^  back bottom burps you can imagine (sorry if TMI).  This back bottom burping is the side effect DH don't like, he does however like having the old Lolly back!  Small price I say.

Hope that garble makes sense!

Lolly XXX
 

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Discussion Starter · #10 ·
Ah-ha!  I get those back bottom burps too....glad it isn't just me!
 
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