Pros and Cons of Metformin for PCOS

by Tallene Posted November 29, 2023

There are four types of polycystic ovary syndrome (PCOS), but most women with PCOS fall into the “insulin-resistant” PCOS category. (Find out your type by taking this quiz.) In fact, research shows up to 80% of Cysters are insulin-resistant. This insulin resistance can progress into type-2 diabetes and other long-term complications if left untreated. Plus, insulin resistance itself causes several irritating symptoms like weight gain, headaches, skin infections, and increased thirst. 

Because of the insulin resistance effect on a Cyster’s body, it’s one of the main side effects of PCOS that doctors work to treat. Often, the drug metformin is prescribed, because it can increase insulin sensitivity and alleviate symptoms. However, there can be several side effects with metformin and there are other factors to consider before making it your go-to treatment method. 

So, today, I’m breaking down the pros and cons of metformin! We’ll also discuss other treatment options if you decide Metformin isn’t for you. Here are the details:

Pros and Cons of Metformin for PCOS

Metformin is not a long-term cure for PCOS. It does not treat PCOS, however, it is seen as safer than oral contraceptives and it can help ease several difficult symptoms. Many women find they’re able to get to a more manageable body weight and improve their fertility. If you’re a Cyster looking for a way to improve your life with PCOS, this probably sounds amazing! 

But, it’s important to always weigh the pros and cons, so you know exactly what you’re getting into. An enthusiastic doctor may miss telling you some downsides and a social media influencer may only tell you the worst-case scenario. The truth is always somewhere in the middle. 

Before you dive in, here’s specifically what metformin does for PCOS

Benefits of Metformin for PCOS

Improves insulin sensitivity. 

Metformin works by triggering AMPK, which is an enzyme that stops gluconeogenesis (production of glucose.) By doing this, metformin is helping your cells respond to insulin, preventing your liver from producing too much glucose and reducing the sugar levels absorbed by the intestines. This is how metformin improves insulin sensitivity, which can alleviate many PCOS symptoms and reduce your risk of developing complications. 

Reduces glucose levels. 

As insulin resistance lowers, of course, your blood glucose levels will lower too! This is because your body is actually able to process glucose into energy, rather than storing it as fat. As blood sugar levels balance, you’ll probably see relief from symptoms like fatigue, intense cravings, frequent urination, and yeast infections. 

Helps with weight loss. 

When your body isn’t storing sugar as fat and you finally kick cravings to the curb, losing weight becomes much easier. On metformin (and similar drugs like Ozempic) many Cysters experience improvements in their BMI (body mass index.) Weight loss itself can also improve your insulin sensitivity, cholesterol levels, blood pressure, sleep health, and fertility.  

Balances testosterone levels. 

Insulin resistance can have a domino effect and impact your hormones, too. Testosterone is often elevated with insulin resistance, causing symptoms like irregular periods, hair loss, mood swings, infertility, hirsutism, and acne. Research has found metformin can indirectly help regulate testosterone by improving insulin resistance, alleviating a number of these side effects. 

Improves fertility. 

Lastly, metformin can increase your chances of conceiving and having a healthy pregnancy. Insulin resistance and hormone imbalance both can cause infertility, so medications remedying these issues have shown to be effective at increasing your chances of having a baby. 

Side Effects of Metformin for PCOS

Depletes body of nutrients like B12. 

One of the main downsides of metformin is the fact that it can deplete your body with essential nutrients like vitamin B12. You’ve probably heard of this one before, and that’s because it’s a big one! A lack of vitamin B12 can cause extreme fatigue, muscle weakness, sore tongue, mouth ulcers, and vision problems—that means metformin could worsen symptoms you’re trying to alleviate using the medication. 

Disrupts the endocrine system. 

An endocrine disruptor is any manmade chemical that interferes with your body’s hormone balance. If you remember, one of metformin’s proposed benefits is hormone balance. However, recent studies have found the hormone-balancing claim questionable, and have instead noticed endocrine-disrupting actions that could negatively affect fertility and other bodily functions. 

Alters the gut microbiome. 

Your gut health has a surprising effect on the rest of your body. It’s essential that your gut microbiome be balanced and healthy to heal PCOS. Studies have found that metformin can either improve or worsen your gut health. 

It varies from person to person, and researchers are still trying to understand the method of action that allows metformin to alter the gut microbiome in the first place. So, understanding how and why it affects people differently is even more foreign and unknown to scientists. Because of this, you should just be cautious of how metformin may affect you.

GI problems. 

One of the most common side effects of metformin is GI problems, which makes sense when you consider how it heavily affects digestion. Cysters report upset stomachs, nausea, abdominal discomfort, and diarrhea. These added symptoms can make you feel like you are spinning wheels with your PCOS healing process, almost as if you’re trading one set of side effects for another! 

Risk of developing lactic acidosis. 

Though rare, there is a risk of lactic acidosis when taking metformin. This is a serious condition where lactic acid builds up in your bloodstream and if consistent, it can ruin your kidney and liver health. This can make your cardiovascular system work in overdrive, leading to organ failure or death in extreme instances. 

Best Alternative to Metformin for PCOS

Truthfully, I don’t think metformin is the best treatment option for PCOS longterm. It comes with lots of side effects and risks, but it doesn’t actually fix the problem. While taking metformin, it can help with insulin resistance but as soon as you get off of it, your insulin resistance and hormone imbalance will likely return, unless you were making diet and lifestyle changes while you were on it. PCOS comes with many challenges and sometimes taking metformin and birth control are the best next step, but as a Registered Dietitian, I always encourage women with PCOS to take charge of their diet and lifestyle while on these medications so they won’t have to take them long term.

If you’re not happy with metformin, you can try Ovasitol which is a natural inositol supplement that has been shown to be just as effective than metformin for many women with PCOS, according to many studies. Only 11.2% of Cysters taking metformin see improvements in their weight, ovulation, and pregnancy. However, 46.7% of Cysters on inositols saw improvements in weight, ovulation, and pregnancy.

The best part? Ovasitol doesn’t have any side effects or risk factors. It simply replenishes your body’s needed ratios of myo-inositol and d-chiro-inositol, which not only helps with insulin levels and the rest of your symptoms but actually helps solve the issue at the root cause! Check it out here. It is crafted specifically for a Cyster’s needs, including dosage and inositol types! You can learn more about this option and the pros of Ovasitol and metformin in this episode of A Cyster and Her Mister.

Consider these pros and cons before taking metformin for PCOS. 

As always, talk to your doctor before considering any alternatives. However, know there is a natural way to reverse your PCOS and finally get symptom relief. You can learn more about these natural methods on the A Cyster and Her Mister podcast and on my blog! I healed my PCOS, and you can too!

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2 thoughts on “Pros and Cons of Metformin for PCOS”

  1. I really wish someone had recommended Metformin to me many years ago. It didn’t hurt to try it, and for me it worked far better than any dietary changes, Ovasitol, etc. I was tracking my lh levels using Inito when I started it, and they dropped to completely normal levels within about 2-3 days of starting Metformin. The same month, I got pregnant and was able to avoid doing IVF. I would recommend it to anyone with PCOS, because it’s really worth a try.

    I’ve never been overweight or had prediabetes btw.

    1. So glad that it ended up working for you! It’s all about finding what works best for you and your body!

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