Women with PCOS (Polycystic Ovarian Syndrome) a common endocrine disorder, often have irregular menstruation, infertility, obesity, acne, mood swings, and unwanted facial or body hair (hirsutism). Often the eggs do not develop to maturity and many small follicles (small fluid-filled sacs containing immature eggs) develop, giving them a "polycystic" (many cysts) look on ultrasound and leading to menstrual irregularity.

All women produce the male hormone testosterone, an important sex hormone, but women generally produce less than 10% of what men produce. Increased testosterone triggers many of the symptoms of PCOS. Although the root cause isn't well understood, there seems to be an interaction between male hormones (testosterone) and insulin. Many PCOS women don't respond properly to insulin. It may be that the insulin released by the pancreas in response to a meal isn't enough to move glucose into the cells properly and the body continues to pump out more insulin. It is possible that extra insulin may stimulate the ovaries to produce more testosterone creating even more insulin in a continuing circle.

Studies have found that some women with PCOS who take Metformin, an insulin sensitizing medication used in the treatment of type II diabetes, show lower testosterone levels, improved insulin response occasionally leading to spontaneous ovulation and improved response to Clomiphene Citrate.

In addition to Metformin, weight loss, especially through reduction of carbohydrates and with increased exercise will help to improve insulin sensitivity.

Your doctor may order base line lab tests before you begin taking Metformin.

HOW TO TAKE METFORMIN:

• Take each dose with a full glass of water.
• Take Metformin with a meal to reduce nausea, diarrhea, and upset stomach that may occur with Metformin therapy. These symptoms are more likely to occur during the first few weeks of therapy.
• Take Metformin once a day (preferably with dinner) the first week;

• A decrease in vitamin B12 may also occur during Metformin therapy. You may need to take a well-balanced vitamin or extra vitamin B12. Women of childbearing age should always make sure at least 400 mcg. of folic acid (folate) daily.

· Avoid excessive alcohol intake while taking Metformin.

· If you miss a dose you can take it soon after but skip the missed dose if it is almost time for your next dose. Do not take a double dose.

SIDE EFFECTS OF METFORMIN:

At the start of therapy some gastrointestinal side effects are common and though annoying are not serious. These include:

These side effects are lessened by starting the medication just once a day, with a meal and with a full glass of water.

Although dizziness is rare it may occur, especially if meals are missed.

Side effects other than those listed may also occur. Talk to your doctor about any side effect that seems unusual or that is especially troublesome.

ALLERGIC SYMPTOMS:

Stop taking Metformin and seek emergency medical attention if you experience the following:

Difficult breathing; closing of the throat, swelling of the lips, tongue or face; or hives.

WHO SHOULD NOT TAKE METFORMIN?

· Someone with kidney disease, heart disease or liver disease.

COPD, or past history of lactic acidosis; or hypersensitivity to Metformin.

· Do not take Metformin if you have moderate to heavy alcohol use.