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PCOS and Metformin

When and How to Use Metformin for PCOS

Some general considerations for using metformin for PCOS include:
  • Usually, metformin is used in women with PCOS who want to become pregnant. For women who do not want to become pregnant, other PCOS treatment is often used.
  • The dose of metformin for PCOS is often between 500 and 2000 mg per day. The dose is usually started at 500 mg daily and slowly increased, in order to prevent side effects. At higher doses, metformin should be split up into two or three doses per day. Be sure to take metformin with food, in order to prevent stomach upset.
  • There is some evidence that taking metformin during pregnancy may decrease the chance of miscarriage. At this time, many healthcare providers recommend staying on metformin for the first trimester (the first 12 weeks) of pregnancy.
  • Because metformin is generally considered to be safe to take during pregnancy (see Metformin and Pregnancy), your healthcare provider may keep you on metformin during your entire pregnancy. Women with PCOS may be at higher risk for gestational diabetes, and staying on metformin may be useful to prevent (or treat) gestational diabetes in some situations.
  • Metformin is often used in combination with Clomid® (clomiphene citrate) in women with PCOS who are having infertility problems. The combination of metformin and Clomid may be more effective than either medication alone. Also, metformin is sometimes used in combination with other infertility treatments, including injectable treatments.

Summary

Although it is not approved for treating PCOS, metformin is commonly used "off-label" to treat this condition, especially in women with infertility problems. Metformin, used alone or in combination with other fertility medications, is often very effective for infertility related to PCOS.
Last reviewed by: Arthur Schoenstadt, MD
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