What your gynecologist may NOT know...

Have been having a back and forth email discussion with a close friend of mine about the recently diagnosed PCO's - some interesting information has surfaced, through this friend being an obstetrics and gynecology registrar, and I thought I should share that information here, as it seems there are a lot of women who aren't getting the correct treatment in terms of PCOS...

so I shall share this information as a series of quotes from the back and forth emails...

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BW: well... we have the answers... had the scan today (internals are not fun!)... definitely not pregnant, but have a lovely pair of polycystic ovaries... which is what I was suspecting! So many things pointed to it. What comes next?

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OR: The next step is to commence Metformin, which is a diabetic drug that combats the insulin resistance that is at the heart of PCOS. In many cases metformin alone will override the abnormal hormone signals and get ovulation (and pregnancy) happening (I have the latest article about it - read it in theatre on Tuesday after my boss gave it to me - can forward a copy if you would like). If that doesn't work after 6 months, you add clomid which will give the second hormone signal to bring about ovulation.

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BW: The GP agrees that it is PCOS, but said nothing about metformin, and didn't order a glucose tolerance test... he has referred me to a gynecologist, but seems to think that even with a known condition, they won't do anything to assist until 12 months is up!

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OR: Maybe GP doesn't know about metformin in PCOS - I guess as it has only been known to be the best firstline treatment for PCOS for a short time (couple of years only - one of our registrars did the research into it as part of her Masters, completed last year) so maybe he hasn't heard yet. The gynaecologist certainly will know about it, as it is widely known in all gynae journals

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BW: Is it metformin still indicated when glucose tolerance tests come back fine? It's just that online I see so many women diagnosed with PCOS who are only given clomid, but not metformin - the idea being that unless there is a problem with the GTT, then metformin won't work?

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OR: Yes - metformin is indicated even with normal GTT. It is designed to combat the insulin resistance that is at the heart of PCOS, which may not be sufficient to cause overt diabetes, but is certainly enough to disturb the generation of the critical sex hormones and tip the balance far enough to cause the ovulation inhibition of PCOS (the signal is disrupted early on, so the follicle only just starts to develop then is stopped prior to ovulation and then just hangs around forming a cyst). the metformin allows the insulin to do what it is meant to and allow your body to make more oestrogen rather than androgen thus allowing ovulation to occur.

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Bold emphasis mine... It appears to me that not all gynecologists out there are up on the latest research, my friend actually works with the person who did the research on the metformin/PCOS stuff... certainly something to ponder.

BW

Yup... I'm one who has PCO and my OB asked me.. do you want to fix the problem or get pregnant? hehe. I said.. well.. both.. so we agreed to start on the Metformin first. I guess if I was really desperate for the baby, he would have given me clomid just to get the eggy happening!

As it turns out, Metformin re-established my cycle pretty much straight away, and I was pg on the 2nd cycle. OB was pleased, coz he didn't like the risk of multiples with Clomid.

The pharmacists who filled my scripts, and friends of mine who work in pharmacies who had enquired about it with their bosses, all of them had never heard of metformin being used for pcos. So it's definitely a newish thing. In fact the pharmacist was quite shocked when I said it would be the last time I'd be filling the script.. coz I guess most people are on it because of diabetes, and are on it for life. So I had to explain the whole thing to him. hehe.

Oh, just by way of note, the OB did no GTT or anything, so he wasn't relating it to diabetes at all, but did explain the insulin resistance thing and how it screws up the hormone cycle.

So I definitely recommend asking your OB about metformin. I'd say GP's etc wouldn't be up on it all as much as the specialists.

to get up to date information you must see a specialist...they are specialised in these fields for a reason.

i was first offered metformin when i was diagnosed with pcos...however it made me too sick then i was put on clomid.

make sure you do a lot of personal research as well as asking specialists for more information. there is heaps of stuff to learn out there

good luck

I'm hoping that the specialists will have the up to date information... it's just the number of women here diagnosed with PCOS that are using clomid only. A few of them have said that because their GTT was normal they didn't need the metformin!

Thing is, PCOS isn't just a problem when TTC, it's a problem for your entire life, and if it's not managed properly, that life is likely to be shortened and possibly not very enjoyable! This is why my friend is so worried about me getting the right treatment!

BW

well you definitley need to see a specialist soon and hope they are good at what they do

you will be in safe hands then

Danni, my appointment is on the 27th of March... The thing that worries me is that nobody seems to have ever heard of the one I'm seeing...

BW

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Thing is, PCOS isn't just a problem when TTC, it's a problem for your entire life, and if it's not managed properly, that life is likely to be shortened and possibly not very enjoyable! This is why my friend is so worried about me getting the right treatment!

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You have no idea how many people don't get this :(

BTW my gyno was absolutely hopeless and said just lose weight, so I got a referral to a well known endocrinologist who diagnosed severe insulin resistance and put me straight on metformin. Who is your specialist BW. Is it a gyno?? From what I have heard form others, most gynos don't look at long term treatment, they just try and get you pregnant :rolleyes:

I've been referred to Dr Chris Saadie in Castle Hill - I've not been able to find out anything about him at all! He is a gynecologist, but I'm suspecting if I don't get put on the metformin my friend will either do some screaming, or give me a copy of the paper to take with me to show him... kind of handy having contacts like that!

Kyliealysha, I notice you are in Sydney also - what area and which is the specialist you saw? If I need a referral to yet another specialist if the gyno falls through, it would be nice to have a name to give my GP rather than having to leave it up to his judgement.

BW

My endocrinologist is Dr Warren Kidson.

He has offices in Randwick, Chatswood and I think Hornsby. He knows a lot about PCOS. You can find him in the yellow pages.

Hi BW,

I was diagnosed with PCOS also but they couldnt see any cysts on my ovaries I just had all the symptoms.

I saw Dr Mark Bowman in Sydney, city, O'Connell St, he is an IVF Specialist also. He firstly prescribed me Clomid which I concieved first cycle but due to my PCOS and low progesterone I miscarried. He then put me on Metformin + Clomid. I was on Metformin for 5 months and concieved this time it worked and I have a healthy pregnancy. Mark Bowman is wonderful and understanding man and will prescribe what is best for you depending on your circumstances. I would totally recommend him, you need a referal from your GP to see him. Feel free to PM me for more info. I actually told Mark my friend takes Metformin and asked him the benefits and he thought it would be beneficial for me.

Re Side Effects of Metformin, if you start the dose really low and increase it every two weeks to the required amount you will not have any or little side effects.

Bel
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yes bel you have a wonderfully progressing pregnancy :D

just beware BW, i started on metformin on a very lose dose and it made me violently ill. I only took 1 tablet and i had the runs and exruciating tummy cramps for 10 hours.

i waited a few days and took another one in case it was something else. and the same thing happened again.

i refused to take another tablet.

i understand that it is probably the best thing for me to be taking, but im not happy to put myself in agony at the same time iykwim.

i hope you have no side effects at all and good luck!

I agree with starting on a low dose and working up to it. My endo started me on half a tablet in the morning for a week before goin up to half in the morning and half at night for the next week. Then gradually adding another half every week up to the full dose.

There are some women who just can't tolerate it, but sometimes they are able to the second time they try (this happened to my friend)

I had a similar problem with starting one of my arthritis medications... I started on the dose the specialist told me, and had awful problems... stopped for two weeks, then started again much slower - I don't have any trouble at all now, and we did find that I had to increase my dose much slower than most people.

I've got so used to managing my arthritis medications (and all the dosage adjustments to go on/off different drugs) that the idea of managing metformin doses and side effects and gradual increases of doses really doesn't worry me at all.

Two weeks today until I see the specialist - at least I'm well armed with what to ask him when I get there now!

BW

BW

Goodluck with your specialist in 2 weeks time, what date are you seeing the specialist ? I hope you are prescribed MET and things will go really well for you.

Danni - I know some people that cannot tolerate Metformin, sorry it happened to you hon, but good to know Clomid it working for you!

Kylie - You are so lucky to be taking Metformin though pregnancy, I so wish my specialist/ob would let me but wont :( I have to have GTT on Friday to see how bad my levels are - sigh.

Bel
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Kylie - You are so lucky to be taking Metformin though pregnancy, I so wish my specialist/ob would let me but wont :( I have to have GTT on Friday to see how bad my levels are - sigh.

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I have another one in a couple of weeks. The endocrinologist based his decision on my age and my weight. I guess getting gestational diabetes would be more of a risk for me that staying on Metformin. He also assured me it's safe fro the baby otherwise I would have stopped.

I'm sure you'll be fine Belle. Exercise and diet are just as helpful from what I have read.

So am I right in understanding from this that metformin should be taken irrespective of your GTT? That all PCOS sufferers should be trying it, not just clomid?

metformin really reduces your insulin.

everyone has very conflicting opinions.

Sophie, i would speak to your doctor first.

I know!! That's why I think I'm confusing myself... my specialist didn't even mention Metformin but a lot of girls seem to be on it

LOL Fletch.. I haven't experienced the upside down chair as yet! Sounds interesting :shock: Perhaps I'll have that privilege at my 6week visit?

OMG... the visions I'm having of this chair!! LOL

I'll keep that in mind if it all turns belly-up! Thanks, Fletch!

BW

Hi!

Just wanted to add my thoughts on so called fertility specialists who don't even mention metformin! My doctor in Melbourne didn't even mention it to me - in fact I never heard of it until I moved to Auckland and saw another doctor. I just went straight on to clomid that as you can see from my sig didn't do an awful lot for me. I didn't ovulate until the third cycle of 150mgs.

Anyways my new dr in Auckland has put me on 1500mgs of metformin and miracles have happened and it looks like after 4 weeks of being on it I have ovulated! \:D/ Not sure if I will be pregnant as we didn't BD at the right time - we were a little late I think - but you never know! Miracles happen! Though this is my first cycle after my D&C following on from my missed miscarriage in March so am not too sure if I am ready to be pregnant again. I guess we'll cross that bridge when I come to it - if I do!

Hi girls,

This is a very interesting thread. I also saw Dr Mark Bowman and had two cycles of IVF but they failed. I decided to take a break from IVF and asked him to prescribe me Metformin. He told me that he didn't think it would work for me as I was not overweight, but was happy to prescribe it as he didn't think it would hurt. Well, I fell pg on Metformin and have a gorgeous bub now.

I am actually TTC again (so soon!) as it took me so long to fall pg the first time. I have moved from Sydney, so just saw a GP and asked to be prescribed Metformin. The GP refused, so I got a referral to an OB/Gyn here who was recommended by women on the POSAA website forums. I am now on Metformin again but the doc wants me to only be on it for five months alone before I go on Clomid. I have been on Clomid for 6 cycles, didn't fall pg and got severe depression, so don't want to do that. But what can I do???

Oh, and I have never been offered an IR test, nor has any doc wanted to address the broader health issues about PCOS, it has always been about how to get me pregnant.

And this is even after some promising new studies have come out, plus that great article from the Australian Magazine a couple of weeks ago.
*sigh*

If your GP does a search on there computer medical journally thing...there is a great article about met and pcos. I went to my GP worried about the GD, he found a great article and even printed it out for his future reference. He prescribed Met right then and there.
My gyn had done a GTT test when I first met him and still diagnosed with pcos but then went on to clomid which did jack!!
However I got GD that had to be treated insulin injections with Eliza but it all settled down afterwards. It just shows that something added to equasion can tip the Blood sugars up.
Bec

i just thought id add maybe there is another underlying reason why met isnt prescribed so often?

i am unable to take it at all. and i have high insulin and am overweight so maybe it could be great for me?

unfortunately it makes me violentally ill and i am unable to tak it.

I really think that it depends on the individual.Like Danni has said it made her soooo sick. My gyno mentioned it but was unwilling to prescribe it to me as my PCOS symptoms were minimal, I'm not overweight and no insulin probems. I was lucky though as clomid works a treat for me and for my sister who also has PCOS in a mild form. Met seems to work so well in some and clomid does in others. I must say though I would be unwilling to take it as it is a insulin reducing drug and like Danni's reaction I would be scared that I might have an adverse affect on it.

The reason so few drs are willing to prescribe it is that its not a legally recognised treatment for PCOS. Its a diabetes drug, not a PCOS one - does that make sense?

I'm not overweight either and my insulin levels are fine but it seems to have helped me. I do have some symptoms, most notably a revolting tummy and the runs every so often but its nothing I can't live with.

I think in hindsight that if clomid hadn't worked for me then I would have been willing to try met. After ttc Gemma for so long I was seriously at my wits end!

when I lived in the UK, I was told by my dr. that metformin was only prescribed to diabetics and I'd have to go to a specialist to try and get some for my pcos.
Anyway, my point is that as it's (seemingly) not widely known about in Oz, perhaps it's for the same reason? I was never offered it here either....was put on clomid and conceived on round three (YIPPEE!).