PCOS - do I need to be on Metformin?

Hi All,

I have a question about Metformin but I will give you a brief rundown of me.

Came off the pill as DH and I decided TTC. A year later, nothing and my cycles were all over the place. My GP sent me to a specialist and it was discovered that I had PCOS. I was put onto Clomid and on the 6 cycle finally got my BFP (after 2 years!!!!).

My world came crashing down when my precious boy was born sleeping at 37 weeks due to a cord accident.

DH and I are TTC again and I am on Clomid again. My ob has not got me on metformin and I asked him why and he said that we would try for a few cycles just on Clomid because I fell pg on Clomid last time. My BT have come back normal but I have read a few things that say your BT can be normal but you may still need to be on Metformin. I am just wondering whether I should tell my ob that I want to be on Metformin or just wait for a few cycles.

Any help on Metformin would be appreciated.

Thanks

I'm so sorry to hear of the loss of little Cooper, Lynn.

I have a friend who is an OB/gyn registrar who has fed me a LOT of information when I was diagnosed with PCOS. She has said that recent studies have shown that metformin is useful in all cases of PCOS, regardless of whether an abnormal GTT result is obtained or not.

I know of people with PCOS where metformin has been all that has been needed in order to restore a normal cycle, while others have still needed the clomid on top... and I seem to be needing one step further and will have to use IVF/ICSI to conceive, but that is also due to issues with my DH as well.

I was diagnosed with PCOS after only three months off OCP. At that point in time my hormone levels were all mainly normal - it appeared to be a very mild case of PCOS and we thought metformin would be enough. Time showed otherwise and metformin didn't help - possibly also due to the fact that the first gyn had me on a dose that was too low. Clomid caused dreadful side effects for me - I had such severe problems with anxiety that I ended up off work for a week, and had the dosage of anti depressents (used to control a mild anxiety problem) tripled just to allow me to start to get back to work. On top of that, clomid did not make me ovulate. It was only my first cycle of 50mg, but the side effects were so severe I just can't contemplate using it again.

For various reasons we changed specialist and I found myself a fertility specialist who was a reproductive endocrinologist as well as a gyn. All my tests were repeated, and we didn't expect anything too different from the first time. I'm not overweight, I don't have excess hair, I have never had an acne problem in my life - the only PCOS symptoms I had where the polycystic ovaries and the complete and utter absence of a menstrual cycle.

However, now at 12 months of being off OCP, my hormone levels were completely messed up - testosterone was now elevated where it wasn't before, my LH/FSH ratio was completely out of whack where before it was normal. And most scary of all - my GTT results showed that even though I lacked obvious symptoms of PCOS, my case is extremely severe. Without metformin, I could probably expect to be type II diabetic very, very quickly. But now, with the right dose of metformin, the right diet and exercise (which I never took seriously before because I thought it wasn't too bad), I'm losing weight and feeling better and more energetic than I have in years.

I know that was a very long ramble, but I've discovered the hard way that PCOS can be worse than it looks and it is important to get the right testing done - reproductive endocrinologists seem to be much more up to date with research than obs and gyns, and I think it would be very much worth while consulting with one to check that all the right tests have been done. Many obs take the philosophy that PCOS is only a problem when TTC, but the associated health problems run much, much deeper than that.

I've become quite passionate about making sure women with PCOS have all the right information and have been tested and diagnosed properly. I apologise that this is a VERY long post, and I hope that somewhere in there is some useful information for you.

BW

BW - thank you so much for all that information. I have tried to do research into PCOS, stillbirths and cord accidents and sometimes I wonder if it is best not to know. There is so much information out there and sometimes it says different things. Other times I think I would like to know everything. It is so hard.

I did ovulate last month (although late) so I guess that it is a good thing - we obviously just missed it iykwim. I haven't had any side effects this time on Clomid. When I was taking it before Cooper, it made me a psycho woman!!!! Poor DH, I don't know how he put up with me. I think that maybe because it hasn't been that long since i gave birth that my body maybe still sorting itself out.

I had a few spots on my chin (but no major acne) and a slight weight problem when I was diagnosed but I seem to be controlling both of those now. With lots of exercising and low gi diet, my weight is dropping. My cycles were all of the place and sometimes I would go months a couple of months but eventually it came. My last cycle which was my first since I had Cooper was 29 days so I am hoping that my body is sorting itself out.

I had 2 GTT done when I was pregnant and they both came back normal. All my BT came back normal too, even the one I had last month. But like you said, the associated heath problems run much deeper so I think I will get some more tests done just to be sure of what is going on.

I appreciate all the information you have given me. I have taken my last Clomid pill today so I think I need to wait this cycle out and see how I go - if BFN, then I think I will get some more testing done and tell my ob that I want to be on Metformin.

I wish you luck with the IVF and hope that you get your BFP very soon.

Don't apologise for the long post - all the information you have given me with help, so thank you.

Lynn, did the GTT return your insulin levels as well or just glucose? My glucose levels are perfect, but my insulin levels were 5 times higher than they should be.

If your insulin levels are normal, and you are losing weight with the current diet and exercise regime, then you are probably ok without metformin. You won't need it, but that's also not to sat you won't benefit from it. It is something that you will need to discuss with your doctor.

BW

BW,

I spoke with my ob today and he confirmed that my GTT were just for glucose and they were normal. Last month I had a blood test and they tested my insulin and it was normal. I have lost weight but I'm not sure if it is from the exericse and diet as I lost a lot of weight when I lost Cooper. I seem to now be stuck at this weight and can't budge it even though I am walking every day (sometimes twice).

My ob said that we would see how I go this cycle and if I get a BFN, then he will do all the tests and ultrasounds to see what my body is up to. Then we will discuss Metformin. I had a different ob who did all these tests before I feel pregnant with Cooper.

He said that a pregnancy can sometimes sort your body out a bit but I will never totally get rid of PCOS.

:crossfingers: that this month I get my BFP and won't have to go through all these tests.

Lynn, I'd really push getting a GTT done that will actually check for insulin levels. My fasting insulin is only slightly elevated (12 when it should be under 10). It's the insulin levels after the glucose load that really frightened my FS!

Many of the problems are hidden, and without the right tests, you may never know how bad it is... as was the case for me. As you are eating right, exercising and still not going anywhere, there's a good chance that you are insulin resistant to some extent.

Your OB is right - sometimes a pregnancy does improve the hormone problems associated with PCOS.

BW

BW,

Thank you for all your help and information. I will speak to my ob again and get a GTT done that checks my insulin levels.

Thanks again
Lynn