Options for Managing PCOS Symptoms

In addition to the options we outlined for managing periods with Polycystic Ovary Syndrome (PCOS), there are other options for managing PCOS symptoms including Metformin and Spironolactone.

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Metformin for PCOS

Metformin is a medication that can help with PCOS concerns because it works to lower insulin levels.

How does it work?

Metformin works in several different ways to improve the insulin resistance caused by PCOS:

• It makes your body more sensitive to insulin.
• It slows the production of sugar (glucose) from the liver.
• It decreases the absorption of carbohydrates when they are eaten.

Lower insulin levels can help with improving cholesterol, fatty liver disease, and pre-diabetes. It can also help improve acanthosis, which is a darkening of the skin in certain areas such as the back of the neck.

Because it lowers insulin levels, and insulin makes the ovaries make extra testosterone, some people with PCOS will also have more regular periods when using metformin. Most teens with PCOS will also use hormonal therapy to help with menstrual periods. or skin concerns.

How do I take metformin?

It is very important to start with a low dose of metformin and increase slowly. There are pills that are short-acting and should be taken 2 times per day. There are also extended-release pills that need to be taken only once per day. Metformin should always be taken with food.

What are the side effects of metformin?

Gastrointestinal side effects are most common. It is very important to start on a low dose and not increase the dose until these side effects have gone away.

They can include:

• Nausea
• Stomach aches
• Gas, bloating, and diarrhea

It can help to take metformin with meals and to avoid very sugary foods that can make the side effects worse. Changing to the extended-release pills can also help.

What else do I need to know about metformin?

• Do not take metformin if you have kidney problems.
• Do not take metformin if you are fasting, and especially if you are not drinking fluids.
• If you are using alcohol, do not take metformin if you are having more than 3 drinks at one time.
• Because metformin can help regulate menstrual period, people with PCOS become more fertile when using this medication. If you are sexually active and not trying to become pregnant, be sure to also use a reliable form of birth control.
• Metformin can cause lower levels of the vitamin B-12. Consider taking a multivitamin or B-12 supplement when using metformin, especially if you are vegetarian or vegan.

How long does it take metformin to work?

• This is different for everyone, but it can take 6-12 months to help with extra hair and acanthosis. Some people will see improvement in acne after 3 months.
• It can take 6-months to help regulate menstrual periods.
• Your doctor will check your labs for pre-diabetes, fatty liver, and cholesterol each year when using metformin.

Can I use metformin to treat PCOS even if I don’t have pre-diabetes or weight concerns?

Yes. Metformin has been shown to be helpful for PCOS-related issues even when people do not have pre-diabetes or weight concerns.

Will metformin help me to lose weight?

Most people do not lose weight when using metformin. If they do lose weight, it is usually because they are less hungry and so eat less. Metformin does help improve cholesterol (fat levels in the blood) and can help to reduce fatty liver which are very important to improve overall health.

How should I get started?

For short-acting metformin:

1. Take a 500 mg once each day. Take with a meal. Do this for 1-2 weeks and do not increase the dose if any stomach aches, gas, or diarrhea.
2. After 1-2 weeks, take 500mg in the morning and evening.
3. After another 1-2 weeks, take 500mg in the morning and 1000mg in the evening.
4. After another 1-2 weeks, take 1000 mg in the morning and 1000mg in the evening. Do not increase the dose if you are having any side effects such as stomach aches, gas, bloating, or diarrhea. Stay at the current dose longer and then increase once these side effects have gone away.

For extended-release metformin:

1. After 1-2 weeks, take 1000mg once each day.
2. After another 1-2 weeks, take 1500mg once each day.
3. After another 1-2 weeks, take 2000mg once each day.

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Spironolactone for PCOS Concerns

Spironolactone is a medication that can help lower the levels of androgens in the skin. It is used to help with:

• Acne
• Extra hair on the face and body (hirsutism)
• Balding of the hair in the temples (androgenic alopecia)
• Hidradenitis, a condition that causes small, painful lumps to form under the skin

How long does it take to work?

It can take 6 months to see positive results. It may help with acne after 3 months.

How do I take it?

• Spironolactone is a medication that can be taken at any time of day and with other medications.
• Your doctor will talk to you about your dose of medication. Common doses are 50- 100mg 1 to 2 times per day.

What are the side effects?

• Most people have no side effects.
• Some people will feel dizzy or light-headed when using spironolactone. This is because it can cause a slight decrease in blood pressure. If you have side effects when using spironolactone, please call your doctor. It is possible that the side effect will get better over time, or you can try a different dose of the medication.

What else to know when using spironolactone:

• Let your doctor know if you have kidney problems or are using other medication for high blood pressure before starting spironolactone.
• It is not necessary to check for high potassium levels before or during use of spironolactone.
• Due its effects on androgen levels, spironolactone is not safe to use if you are pregnant or planning to become pregnant soon. If you are sexually active, it is OK to use spironolactone if you are also using an effective form of birth control.
• It is safe to use spironolactone with other hormonal medications, including all types of birth control pills.