The drug of first choice for women with PCOD today is metformin ( this medicine is also used for treating patients with diabetes. ) Doctors have now learned that many patients with PCOD also have insulin resistance, a condition similar to that found in diabetics, in that they have raised levels of insulin in their blood ( hyperinsulinemia) , and their response to insulin is blunted.
This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
Metformin is rapidly absorbed from the small intestine with peak plasma levels occurring two hours after ingestion unless taken with food, which delays both. Metformin is available in 500 mg, 850 mg, and 1000 mg tablets. An extended release form is available in 500 mg tablets. Clinical results are usually observed at doses between 1500 mg and 2550 mg daily. Resumption of cycle regularity is dependent on the length of treatment with metformin. Most individuals require 4-6 months of metformin treatment before they begin to ovulate.
There is overwhelming evidence from at least three well performed randomized controlled trials and several cohort studies indicating that when taken with clomiphene citrate, metformin enhances the probability of ovulation and pregnancy. There is controversy over the mechanism of action. Some suggest that these outcomes were due to the weight loss that results when using metformin.
Only a few studies have shown that metformin has no or minimal effect on insulin resistance and these studies were in morbidly obese PCO patients or when there was no weight loss. Numerous studies have shown that metformin is effective in both obese and thin women correcting insulin metabolism, endocrine parameters or both. Research is not clear as to whether it should be continued throughout pregnancy.
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