Title: All things PCOS and Metformin
Metformin is a Type 2 Diabetes medication that is commonly used in PCOS. While not all women with PCOS have insulin resistance, women living with PCOS are twice as likely to develop metabolic syndrome (1).
Metabolic syndrome is characterized by high blood pressure, insulin resistance (pre-diabetes or type 2 diabetes), increased abdominal adiposity and high cholesterol. Together, the listed conditions increase our chances of heart attack, stroke, and kidney disease.
If you've been following along on the blog, you'll know that high dietary AGEs are a marker of PCOS and insulin resistance. Read more about that here, here and here.
Insulin resistance is the cause of Pre-diabetes and Type 2 Diabetes. This may also be a contributing factors in PCOS, with over half of women with PCOS found to have insulin resistance, measured by HOMA-IR (a simple blood test)(2). While we don't know the exact cause of PCOS, the leading theory states that insulin resistance leads to higher androgen levels in the body and stimulates the ovaries and adrenal glands to make even more androgens (like testosterone) which alters the menstrual cycle (2). This, along with dietary AGEs, are thought to lead to irregular menstrual cycles, male pattern hair growth, and hormonal dysfunction (2)(3). We don't know for sure exactly what is causing this, but we do know that these things play a role.
Interestingly, when we treat women who have PCOS with Metformin, we do tend to see an improvement in ovulation (4). Presumably, treating the underlying insulin resistance is thought to improve the hormonal profile (4).
Current pharmaceutical treatment methods focus on using hormonal birth control methods to lower the risk of breast and uterine cancer associated with anovulatory cycles (1). Anovulatory cycles are menstrual cycles where our body does not release an egg. There are also medications like Clomiphene (Clomid) which are used to help us release an egg when we are seeking pregnancy (4).
Okay, but what about if we don't want to take medication for this? Is weight loss enough to improve ovulation? There are a handful of small trials that have shown that weight loss can improve ovulation and fertility rates (5). If we have time to make changes before we plan to conceive, then there are a plethora of reasons to aim for an ideal body weight and make improvements to our diet and lifestyles as a therapeutic option. According to the American College of Obstetrics and Gynecologists (ACOG), obtaining a healthy weight prior to pregnancy can lower the risk for multiple pregnancy complications for both us and our baby (6).
So what changes can we make? We can focus on eating whole foods and avoiding processed foods. We can increase our fiber intake and reduce our saturated fat. We can transition towards a vegetarian plant-predominant dietary pattern to reduce our dietary intake of AGEs. All of these steps can be used to reach an ideal weight and combat insulin resistance.
Here at Lifestyle Medicine Maine, our clinician has experience helping clients reduce insulin resistance through dietary changes. We offer a 12 week therapeutic weight loss and wellness peer support group that meets on Sunday's from 10am to 11am. Together, we explore the underlying cause of our weight gain and put into practice the things that "we know we should be doing". Making changes is easier with friends. If you are looking for intensive support to try to improve PCOS symptoms and you're ready to put your knowledge into practice, then join us for session 02 of our peer support group beginning April 7th. Schedule a free consultation today to discuss your health concerns and make sure that we're a good match. See you soon!
References
Diagnosis and Treatment of Polycystic Ovary Syndrome. Williams, et al. American Family Physician. (2016) https://www.aafp.org/pubs/afp/issues/2016/0715/p106.html
Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. DeUgarte, et al. Fertility and Sterility. (2005) https://doi.org/10.1016/j.fertnstert.2004.11.070
Increased serum advanced glycation end-products is a distinct finding in lean women with polycystic ovary syndrome (PCOS). Diamanti-Kandarakis, et al. Endocrinology. (2008) https://doi.org/10.1111/j.1365-2265.2008.03247.x
Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline. Practice Committee of the American Society for Reproductive Medicine. Fertility and Sterility. (2017) https://doi.org/10.1016/j.fertnstert.2017.06.026
How to manage weight loss in women with obesity and PCOS seeking fertility? Hazlehurst, et al. Clinical Endocrinology. (2022) https://onlinelibrary.wiley.com/doi/pdf/10.1111/cen.14726
Good Health Before Pregnancy: Prepregnancy Care. American College of Obstetrics and Gynecologists (ACOG). (n.d.) https://www.acog.org/womens-health/faqs/good-health-before-pregnancy-prepregnancy-care#:~:text=Eating%20a%20healthy%20diet%20and,taken%20for%20a%20nonmedical%20reason)
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