Some of the most common side effects of metformin include:. Slowly increasing your metformin dose over several weeks can help you avoid these issues. If you have ongoing digestive issues, your healthcare provider may switch you to the extended-release version of metformin, which is gentler on the digestive system and better tolerated. Metformin should be taken with food to minimize side effects.
However, you should avoid eating sugary and processed foods, as they can worsen the digestive side effects of the medication. Long-term use and high doses of metformin increase the likelihood of vitamin B12 deficiency.
A lack of vitamin B12 can cause mood changes, memory loss, and damage to the nervous system. While taking this drug, you should supplement your diet with vitamin B12 and have your levels checked annually. Elevated serum homocysteine and urinary methylmalonic acid MMA levels, the gold standard in assessing B12 status, also indicate a B12 deficiency.
The most serious side effect of metformin is lactic acidosis, a potentially life-threatening condition caused by the buildup of lactic acid in the blood. This can occur if too much metformin accumulates in the blood due to overdose or chronic or acute kidney problems. If you have serious kidney problems, you shouldn't take metformin. Drinking alcohol while on metformin, and especially binge drinking, can increase your risk of lactic acidosis.
Some medications can also increase the risk, including:. Symptoms of lactic acidosis include:. You can prevent lactic acidosis by:. If you develop symptoms of lactic acidosis, get medical attention right away. There is no natural substitute for metformin.
However, there are natural ways to improve your insulin sensitivity in other ways. The most important things are eating a healthy diet and getting regular physical activity. N-acetyl cysteine is an antioxidant that was shown in one randomized controlled trial to work as well as metformin for reducing insulin resistance and cholesterol in people with PCOS. Myo-inositol was found to restore ovulation, resulting in more pregnancies than metformin.
Myo-inositol has also been shown to improve insulin and other metabolic aspects of PCOS. Regular menstrual cycles usually return within about six months in women with PCOS taking metformin. Some studies have shown that women without PCOS may benefit from using metformin for infertility. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society disease state clinical review: Guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - part 2.
Endocr Pract. Off-label drug use in the treatment of polycystic ovary syndrome. Fertil Steril. Metformin use in practice: compliance with guidelines for patients with diabetes and preserved renal function. Clin Diabetes. The clinical application of metformin in children and adolescents: A short update. Acta Biomed.
Published Sep 7. Prescribers' Digital Reference. Metformin hydrochloride - Drug summary. Metformin: a review of its potential indications. Drug Des Devel Ther. Published Aug Priya G, Kalra S. Metformin in the management of diabetes during pregnancy and lactation.
Drugs Context. Killoran says that there are a few medications that may be prescribed for PCOS patients, depending on how the condition affects them. This is not a complete list, but it includes:. Killoran adds. Metformin is a common medication used to treat PCOS symptoms. Laurence Gerlis , a general practitioner in London, England. Gerlis says metformin for PCOS, when taken regularly, will lower blood glucose levels by balancing insulin levels and decreasing other metabolic effects of the condition.
There are very few safety issues related to regular use of metformin, other than the loosening of bowels, Dr.
Gerlis says. Gas, diarrhea, and stomach pain are some common side effects of metformin. Gersh, on the other hand, does not prescribe metformin to her patients because it has been classified as an endocrine disruptor by some environmental scientists. Although there is much controversy surrounding them, endocrine disruptors have been suspected to be associated with altered reproductive function, breast cancer, irregular growth patterns, and more.
There is no consensus on a standard dose or duration of metformin for PCOS; the median dose is 1, mg daily. Physicians often start patients on mg daily, and increase the dose gradually to reduce side effects of metformin. Metformin is taken orally, and is available under the brands Fortamet, Glucophage , Glumetza , and Riomet.
The effects of metformin on the body's response to insulin suggest it might be helpful in managing the symptoms of PCOS, for example in women who don't want to take other treatments or for whom these aren't suitable.
Metformin has a license in the UK for treating type 2 diabetes, particularly for people who are overweight. However it does not have a license for use in PCOS, so use in this way is described as 'off-label'.
It is important to note that metformin is not a contraceptive.
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