Metformin and pregnancy

Hey all,

Firstly i apologize if this is in the wrong place.

I've been on metformin for around 6 months now for PCOS. I fell pregnant and my GP told me to stay on it. I since saw another GP for various reasons who was really great, but he told me that I shouldn't be taking metformin at all during pregnancy and should have stopped it when I found out. I know there's two school's of thought with doctors of whether you should be on it or not.

I am now 9 weeks and been off metformin since Monday. Since I stopped, I have had the most horrific migraine that won't go away. This worries me because I just don't get migraines in pregnancy, they are a hormonal thing that I only get the week of my period. I rang my GP as I was concerned that this somehow means that because I stopped metformin that my progesterone is dropping which is what triggers a migraine. He said metformin doesn't control hormones, it makes you lose weight which is what fixes hormones (I lost 15 kg in the 6 months on metformin, also using a low carb diet) so that stopping it won't cause anything and it's just a coincidence.

My bleeding was worse today, I've had constant bleeding since 5 weeks due to a blood clot under the placenta, but the migraine and worseing bleeding is worrying me.

So I have a couple of questions for anyone who has had any experience with conceiving after PCOS and metformin:
-did you stay on your metformin in pregnancy, if so how long?
-did anyone experience withdrawal symptoms like migraines when stopping metformin?

Any information or experiences in general with this would be much appreciated.

Thankyou
Naomi

Naomi,

Firstly, congrats on the pregnancy... and hope it sticks. Sorry to hear about the bleeding.

I have PCOS as well and have been on Metformin for 6 months as well (although am still not pregnant).

If you have PCOS /IR and conceived on Metformin, generally docs consider the benefits of staying on it during the pregnancy to outweigh the risks. I think most women stop at 14 weeks, but some, if their blood glucose levels are rising during the pregnancy, will stay on it for the whole pregnancy.

I don't know anything about the relationship between Metformin, PCOS and migraines. But what your docs says about Metformin doesn't sound 100% right... it is an insulin-sensitising drug and insulin is a hormone. My understanding is that the endocrine system is a perfectly assembled orchestra and if one hormone plays out of tune the others try to compensate for it. So I would say that Metformin has more of an effect on hormones that we tend to think, simply because it is helping to control your insulin.

**RANT**I have a big dislike of the whole "metformin just makes you lose weight" line! I am a "normal" weight woman with insulin resistance... my weight doesn't come into the equation, but my insulin still does. Yes, for some women, the weightloss will result in ovulation being restored without the need for Metformin, but for other women, this is not an option, since they have no weight to lose and yet their insulin is still too high.**END RANT**

That doesn't help you in your situation though. Are you on a high enough amount of folate? Are you taking any aspirin to help with the clot? (Don't take the aspirin without first talking to your doctor). Folate can sometimes help with reducing clotting, since homocysteine increases clotting and folate can reduce homocysteine levels (and homocysteine is often elevated in women with PCOS). The Elevit tablets contain a good amount.

Maybe talk to your doctor about taking aspirin, if you are not already taking it. I'm not a doc, but I know some women w/ PCOS take half a tab throughout ttc and pregnancy since it can help some women w/ PCOS to reduce their chances of m/c'ing.

I'm not an expert... but hope this helps in some way. :)

I take metformin for PCOS, have been on it since March, but still not pregnant.

My gyn told me that if I conceived, I should stay on the metformin through first trimester at least. My GP told me to stop.

Fortunately, I'm in the situation of having a friend who is nearly finished her studies to become a specialist obs/gyn. It's new research, and not everyone knows about it, especially at the GP level. Metformin is considered fine during pregnancy, and it actually reduces the risk of miscarriage that is associated with PCOS.

Your new GP may mean well, but they aren't up to date with the PCOS and metformin literature.

BW

Congrats on the pregnancy, Naomi! I don't take metformin, but I do work in healthcare and part of my job is with high-risk pregnancies (I hate the sound of that, it's mostly people with chronic conditions and are pregnant). I will second what BW has told you: Metformin can be taken safely thoughout pregnancy, although it does not have a product licence for this. It is usually discontinued, although if you've had previous miscarriages after discontinuing the drug then you are usually kept on it until the second trimester at least. I deal with no small number of pregnant PCOS Metformin women: the main reason it's discontinued appears, to me, to be a cost thing as coing off the drug doesn't seem to give any benefit to the mother or foetus. But that's the NHS for you!

Also, metformin doesn't even help every overweight person lose weight: it is used in diabetics to help this, but they don't always lose weight. Metformin is a great drug for type IIs who don't want to be on insulin, but need something other than diet to sort out their hormones. PCOS women usually have some degree of insulin resistance and it's vitally important for a young developing embryo and foetus to have that sorted out - if it's not then there could be developmental problems. This is why most PCOS specialists - not always a obs/gyne, could be an endocrinologist - will leave you on Metformin for the first trimester if coming off it has caused problems before.

In Australia, you pay for all your drugs anyway, right? So you should have no problem with staying on the drug for as long as you need to.

I'm not going to say that Metformin is safe in pregnancy or not , but from my experience with Metformin and my pregnancies, I have stopped taking it as soon as I found out that I was pregnant (both my OB/GYN and endocrinogist advised me to do so.) I'm also a nurse but it was my choice to stop the metformin and my choice only for my baby.
I never had any withdrawals from stopping the drug either.

Thankyou so much, all your replies really helped me to make an informed choice before I saw the doctor. There is so much conflicting advise about metformin and the biggy is that it's still rated a category C drug in pregnancy. My original GP had only advised me to stay off it after he rang a gynae for advise. Before my case, he'd had nothing to do with PCOS or metformin to treat it, so that really helped because he was willing to get more information on it which happened to be the latest info.

The other GP i saw told me to stop and wouldnt give me another script for it. I went back to the other GP because I had the migraine from hell, which I NEVER get when I am pregnant, I only get them the week of my period and I was very worried that this had meant ceasing metformin had caused a progesterone drop. I had this migraine from last Sunday till Saturday, it was a nightmare because I could only take panadeine forte and that didn't even touch the pain.

Anyway, due to me being off metformin since Sunday, the doctor who I saw on Friday said there was no point in starting it again now because of the side effects and he was concerned about that in pregnancy (I get the sideeffects really bad from it). I agree with that, i can't imagine going through all that again while pregnant.

I'm getting a scan tomorrow and I'm thinking that the larger bleed wasn't anything to do with Metformin either, it was just timing.

:pray: I'm just hoping to see a little HB and a moving little bubba

Naomi,

How did the can go yesterday?

Hope all is well.

I continued to take it as studies show it reduces the risks of Gestational Diabetes if continued to be taken during the first trimester. My son is now here and he's perfect :D I also believe it stopped me from having a miscarriage, as I had had with previous pregnancies.

*hugs*
Cailin

It 's a hard one, in the future (if there are more babies) I will definately be staying on it the whole first trimester. I still would be on it now if I hadn't been taken off it and my script had run out. But I can see why it wouldn't be a good idea not to start it again after a week of being off it.

My scan went great! 180bpm and very healthy growing to date little 10 week old bub. The bleeding ended up being a good thing, the large blood clot I had under the baby before had bled out, so that's what all the blood has been and it's now very small the clot.

I'm very happy :confetti:

:hello: Tara,

Sooooooo glad things r looking up:) Its good to c that u sound so much more +ve u will be in my thoughts. :hug:

Ur lil bubs is a fighter ........so happy 4 u, continue to keep us posted on ur pg, looking forward to it. Take care hun.

Bye
Malimum :heartbeat:

Hi all!

Ive been reading alot on this website and today is my first time posting a thread.

I am 25 Years old (overweight) and have been TCC for the past 14months. I have never been on the pill so was a bit concerned when nothing was happening after trying for 1 year.

I went numerous time to my GP and he just said keep trying ... keeping trying.

Eventually after numerous blood tests and ultrasounds he concluded i may have PCOS.
He prescribed Metformin 2 tables a day. I have been on it for 1 month and today i got my period :wall:

I am trying not to get too depressed but im am wondering how long it is going to take on metformin to conceive?

Could anyone let me know how long it takes on Metformin?

Im going to see my doctor this week and get a another blood test to check my glucose levels.

Lets see what happens.

I see and Endocrinologist who was one of the first to start using Metformin for PCOS. He has written many papers and given lecture both here and OS regarding the benefits.

My advice would be certainly not to stop the medication. I suggest you speak to an OB or an Endocrinologist. As Cailin pointed out - studies have shown it can help prevent GD during pregnancy.

I don't think all GP's really have enough knowledge in this area. I urge you to seek some advice from someone that really specialises in this area. My IVF doc has also told me that metformin continues during pregnancy.

All the best..