PCOS Messages for November, 2002: Re: Just back from the doc's...questions

Re: Just back from the doc's...questions

From: anonymous@obgyn.net
Thu, 14 Nov 2002 15:01:52 -0600 (CST)

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Hi there,

I'm 19 and have been on met for a year now for PCOS, i just ran into this on the net and thought it might help you out, has made me have a wee re-think about met anyway....

Insulin-sensitising drugs - metformin PCOS can lead to a resistance to insulin, leading to the body producing excessively high levels in an attempt to compensate. This higher level of insulin is known to cause abnormal cholesterol and lipid levels, obesity, irregular periods, higher levels of androgens, infertility due to disturbance of ovulation and an increased likelihood of diabetes. Metformin is a type of drug known as an 'insulin-sensitising agent', which lowers the blood sugar level, in turn reducing the excessively high insulin.

There are actually very few studies that have been carried out and published concerning the use of insulin sensitising drugs as a treatment for PCOS. These suggest that it may well be useful in several areas: helping weight reduction, improving irregular periods (70%), normalising blood cholesterol and leading to ovulation. One study looking at ovulation in particular found that compared to no treatment, 34% of women ovulated taking metformin (compared to 4% who did not receive it) and when this was combined with clomiphene it was as high as 90% (as compared to 8% in those who only received clomiphene). These studies contained overweight women with PCOS - its role in treating women of normal weight has not been investigated. The most common side effects during treatment are diarrhoea, nausea, vomiting and abdominal bloating.

Early studies The studies that are available concerning the insulin-sensitising drugs are very exciting and will hopefully pave the way for a longer-term treatment for this disease, which can affect many different areas of a woman's life. It is important to realise that the investigation is still at a very early stage. Long-term effects are not known - the longest follow up so far is for around 6 months of use. Considering its use as a treatment for infertility, the studies are small compared to more traditional treatments, containing only up to 35 patients receiving metformin. Most studies are not comparative, in that they did not compare 'treatment' with 'no treatment', an extremely important point. The outcome of the studies has looked at the effect on ovulation rather than actual pregnancy or birth rates. We know from clomiphene that only half of women who ovulate actually get pregnant - what is the figure for these newer drugs?

Because of the lack of research using these drugs, many doctors are awaiting further studies to confirm their initial apparent success and identify potential side effects before jumping in and prescribing them. This is a safe and sensible approach. There may be specific cases when their use is considered appropriate at this stage, and this is something for an individual doctor to decide with the patient's full understanding of the present situation.

i know its a lot to read but hopefully it helped. :)

Emily, GLasgow, Scotland

At Thu, 14 Nov 2002, Jenn wrote: >
>Hey Gals!
>I just got back from the NP and she and I have to decided that it would
>be best that she doesn't treat me for my PCOS since she's not real up on
>it (however, I'll see her for other stuff). Being the great NP that she
>is, she did some research (calling the OBGyn's she used to work with)
>and they told her that they are only giving Met/Gluc. to women who are
>trying to conceive AND that the main reason Cysters switch doctors is
>because the doctor wants to take them off the Met. Apparently they are
>affraid that eventually the pancreas will shut down and rely only on the
>Met. I asked her "so what do they suggest we do?" and she said just
>treat it with hormones. I told her that is not treating the cause, just
>puting a band-aid over it which is unacceptable. Has anyone ran into
>this? I see another doc who is pretty up on PCOS related stuff and she
>is pro-Met so I'm not worried but I'm currious if any of you have run
>into the theory that the Pancreas will eventually shut down. Won't it
>eventually shut down if your body is pumping out all that insulin
>anyway?
>--Jenn (nif)

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