Metformin Manifesto

1. Metformin is not an easy drug to get used to.

There is no two ways about it; Metformin is not the easiest drug in the world to adapt your body to. According to the manufacturer, here are the most common side effects of Metformin, which are more pronounced when you first start taking it.

  • Nausea, vomiting, abdominal pain, or diarrhea at the start of therapy;
  • Abdominal bloating or increased gas production; or
  • Decreased appetite or changes in taste (metallic taste in your mouth).

Also: Metformin does not usually cause hypoglycemia (low blood sugar). Nevertheless, hypoglycemia may occur in the treatment of diabetes, as a result of skipped meals, excessive exercise, or alcohol consumption. Know the signs and symptoms of low blood sugar, which include hunger, headache, drowsiness, weakness, dizziness, a fast heartbeat, sweating, tremor, and nausea. Carry a non-dietetic candy or glucose tablets to treat episodes of low blood sugar.

There are a number of other side effects people are attributing to Metformin that I cannot find mentioned in statistical study literature about the drug, even in the literature that is supposed to report all the side effects people experience, not just the most common ones. When in doubt, ask your physician, but not everything you will experience while you're on Metformin is attributable to Metformin.

2. Not altering your diet and exercise routine can make Metformin even harder to adapt to.

From the manufacturer’s drug information: Always remember that Glucophage is an aid to, not a substitute for, good diet and exercise. Failure to follow a sound diet and exercise plan can lead to serious complications such as dangerously high or low blood sugar levels.

Especially if you are already insulin resistant, not altering your diet once you are on Metformin can not only make you sick, it can also counteract the Metformin's ability to normalize your insulin levels. Over time, I have seen people have the most amount of success if they reduce the number of carbs and sugary foods they eat. That does not necessarily mean low-carb or an Atkins diet. But if your diet right now consists of cereal for breakfast, a white-bread sandwich and potato chips for lunch, popcorn for a snack and pasta for dinner, you will probably experience a greater degree of discomfort and distress on Metformin. Learning how to integrate healthy protein into your diet, combine protein with carbs, and find appropriate substitutes for white carbs in your diet can go a long way to helping you adjust to the medication.

I really can't say enough about exercise as a way of helping control your insulin. Several studies have found that people who adapted an appropriate diet and exercise routine had a better chance of preventing diabetes even if they didn't take Metformin. Exercise is proven to lower insulin levels for a period of time after your workout is over, and there's a lot regular exercise can do for your mood and stress level, as well as your insulin levels.

3. If you are having a hard time on Metformin, it will probably not last forever. But you may need to experiment with how you take your Metformin so that you find something that works for you.

People tend to have the most problems on Metformin in the first two to three months of therapy. As your body adjusts, you will feel better. That does not mean that you will not occasionally still have days where you feel sick if you eat the wrong thing or just have a bad day. Experiencing some amount of discomfort is not out of the ordinary. In this way, the side effects from Metformin are no different than the other discomforts we all have to bear in this life. If the Metformin helps you get pregnant, there will be a whole other set of discomforts and inconveniences you will have to bear, but those will seem pretty insignificant in comparison to what you're getting in return. I looked at the side effects I had to put up with from Metformin the same way I look at my pregnancy nausea now - it's something I have to tough it through to get to my goal. Bear in mind that if you are taking 1500mg, the minimum therapeutic dose for PCOS, you are actually taking MORE Metformin than the standard therapeutic dose diabetics are advised to take, which is 1000mg. So your side effects may be more intense than those of people you know who are taking it purely for diabetes treatment.

However, if you're having problems, experiment with how you're taking it. Some things I have seen people try that have worked:

  • Taking it with milk.  "Milk" and "dairy products" are not the same - taking it with yogurt may cause you problems, it seems to with a lot of people
  • Taking it after meals (people have greater success if they take it after lower-carb meals, but salad usually does not combine well with Met.)
  • Taking it in between meals, if taking it after meals doesn't work
  • Taking it with Wonder Bread
  • Drinking more water
  • Experimenting with giving up certain foods, even if they are your favorite foods.
  • Switching to Metformin XR, which has fewer side effects for many people (some doctors don't think it's as effective as regular Metformin though)

4. In my experience, Metformin usually works only as well as the effort you put into it.

I did not get pregnant on Metformin until I took the dose that offered me the most therapeutic benefits in a consistent way over a period of several weeks. When I would take it inconsistently (at different times of day), skip doses, take different doses on different days, and generally not be disciplined about how I took it, it did not have that therapeutic of an effect for me. Most of the people I know from boards and IRL who have gotten pregnant on Metformin did so when they were regimented about their therapy. If you take the Metformin haphazardly, you may not experience the same good results you would get if you took it more consistently.

5. Metformin is, currently, the best and most thoroughly researched treatment for PCOS.

Metformin is far from perfect. The side effects are not pleasant. However, right now there's no other treatment for PCOS that has been proven to be as effective. Metformin has three big advantages:

  • It's been researched in hundreds of controlled studies that demonstrate its effectiveness.
  • It's been safely used in Europe for over 40 years, even though it's only been approved for use in the United States for about 10 years or so.
  • It's a Class B drug, meaning it is not known to cause any birth defects and is generally regarded as safe for pregnancy by many doctors.

The two new Metformin substitutes, Actos and Avandia, do show promise as PCOS treatments. However, their long-term safety and safety in pregnancy has not been established, and it's also not been determined that they are as effective as treating PCOS as Metformin is. My opinion is that those studies are coming, but until then many doctors are going to be reluctant to prescribe Actos and Avandia for PCOS treatment.

If you have a great deal of difficulty on Metformin, and can't seem to get adjusted to it no matter how long you're on it or how you take it, you may need to talk to your doctor about other options. However, and this is just my opinion, not taking anything to treat your PCOS shouldn't be one of those options. PCOS increases risks for a lot of very unpleasant health conditions, including:

  • Development of full-blown Type II diabetes (somewhere around 70 percent of people will develop Type II diabetes within 10 years of their PCOS diagnosis). Long-term Type II diabetics are at risk for a number of health complications, including diabetic neuropathy, limb amputation, blindness and other bad things if their diabetes is poorly controlled.
  • Increased risk of heart disease and stroke
  • Continuing reproductive complications aside from infertility, including increased risks of cancer of the uterus, breast and ovaries. Continued cycle irregularity can increase your risk of needing a hysterectomy to control abnormal tissue growth inside the uterus (endometrial hyperplasia).

6. Metformin is beneficial for pregnancy thru the first trimester.

If you become pregnant and are not on Metformin, and do not continue to take Metformin for at least several weeks after pregnancy is confirmed, the statistics regarding pregnancy success are not encouraging:

  • A couple of different studies have found that in PCOSers not medicated with Metformin, the miscarriage rate ranged from 45-60 percent.
  • PCOSers with uncontrolled hyperinsulinemia have about a 60-80 percent chance of developing gestational diabetes when they do become pregnant.
  • If you are a PCOSer with high LH (luteinizing hormone), you should be aware that LH is embryo toxic and can kill a dividing fertilized egg. Your LH is not supposed to be high in the luteal phase of your cycle, and the two conditions - pregnancy and elevated LH levels - are more or less incompatible, as was proved in a Japanese study several years ago.
  • High insulin levels during pregnancy have been linked not only to pregnancy loss, but also to an increased risk of birth defects.
Metformin therapy has a lot of benefits, as you can see. It is not a perfect therapy, but it is the best one we have right now. I can assure you that once you become pregnant, the discomforts you had to cope with on Metformin will seem very insignificant.