Can Diabetes Medicine Help PCOS? I KL Fertility

Introduction 

Polycystic Ovary Syndrome (PCOS) is a prevalent hormonal disorder impacting numerous women of reproductive age. Interestingly, metformin, a medication primarily used for diabetes management, has been proven to be an effective treatment option for PCOS. This article delves into the reasons behind metformin’s use for PCOS, steps to take if it proves ineffective, potential side effects of other medications, the significance of maintaining a healthy BMI, and the need for specialized care during pregnancy. Insulin resistance, a shared issue in PCOS and diabetes, makes managing insulin levels essential for alleviating PCOS symptoms and enhancing fertility. As a KL Fertility centre, Golden Gate agree with the use of diabetes medications like metformin that can increase insulin sensitivity, diminish PCOS symptoms, and boost reproductive functions.  

Why Do People Treat PCOS with Metformin, a Diabetic Medication? 

Polycystic Ovary Syndrome (PCOS) can significantly impact pregnancy, presenting challenges such as irregular menstrual cycles, ovarian cysts, and hormonal imbalances that complicate conception and maintenance of pregnancy. Metformin is commonly prescribed to manage PCOS because it addresses insulin resistance, a key issue in many women with this condition. The progression from insulin resistance to diabetes in PCOS patients involves complex metabolic and endocrine changes, emphasizing the need for targeted interventions to manage these risks effectively.  

Metformin enhances the body’s response to insulin, which helps lower blood sugar levels and reduces the risk of developing type 2 diabetes. At the same time, this will reduce the symptoms of PCOS and improve the chances of ovulation. Additionally, integrating lifestyle modifications and medical treatments could help mitigate the impact of insulin resistance and improve overall health outcomes for women with PCOS (Condorelli et al., 2017). By treating PCOS, it is anticipated to increase the chances of pregnancy too. 

What if metformin did not increase the chances of pregnancy? 

If metformin alone does not result in pregnancy, other fertility treatments can be considered. The next steps often include medications like letrozole, Clomid (clomiphene citrate), or gonadotropins. Letrozole is an aromatase inhibitor that reduces estrogen levels, prompting the pituitary gland to release more follicle-stimulating hormone (FSH). This stimulates the ovaries to produce more follicles, increasing the chances of ovulation. On the other hand, clomid (Clomiphene Citrate) is a selective estrogen receptor modulator (SERM) that tricks the body into thinking estrogen levels are low, which also stimulates the release of FSH and luteinizing hormone (LH), promoting ovulation. Both letrozole and clomid are typically used as first-line treatments for inducing ovulation.  

Another systemic administration of treatment is injectable gonadotropin hormones such as FSH and LH, which directly stimulate the ovaries to produce multiple follicles. This is often used  when oral medications like letrozole and Clomid are ineffective. While gonadotropins can be effective in inducing ovulation, they come with potential side effects, especially in women with PCOS. 

Common side effects as listed below:  

• Ovarian Hyperstimulation Syndrome (OHSS): A condition where the ovaries become swollen and painful. It can cause abdominal pain, bloating, and, in severe cases, shortness of breath and blood clots. 

• Multiple Pregnancies: Increased risk of twins or triplets, which can pose additional health risks to both the mother and the babies. 

• Mood Swings: Hormonal changes can lead to mood swings, anxiety, and depression. 

• Injection Site Reactions: Pain, redness, or swelling at the injection site. 

Healthy Body Mass Index (BMI) for Pregnancy 

Maintaining a healthy BMI is crucial for fertility and a healthy pregnancy. A BMI between 18.5 and 24.9 is considered ideal for conception and pregnancy. A BMI of 30 or above is considered obese. Losing even a small amount of weight can significantly improve fertility. Research suggests that losing 5-10% of your body weight can enhance ovulation and increase the chances of pregnancy. A high BMI can increase the risk of complications during pregnancy for both the mother and the baby, as listed below:  

• Gestational Diabetes: Higher likelihood of developing diabetes during pregnancy. 

• Preeclampsia: High blood pressure during pregnancy can damage to multiple organs including causing brain damage or even death.  

• Preterm Birth: Greater chance of delivering the baby before 37 weeks of gestation. 

• Birth Defects: Higher risk of neural tube defects and other congenital anomalies. 

• Large for Gestational Age: Babies may be larger than average, leading to complications during delivery (nhs.uk, 2017). 

The best way to lose weight to increase fertility involves a combination of a healthy diet, regular exercise, and lifestyle changes. A balanced diet should be rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, with an emphasis on low glycemic index foods to manage blood sugar and improve insulin sensitivity. Consistent exercise, including at least 150 minutes of moderate-intensity activity per week, combining aerobic exercises like walking, swimming, or cycling with strength training, is crucial. Additionally, reducing stress through activities like yoga, meditation, or deep breathing exercises, and ensuring adequate sleep (7-9 hours per night) are important lifestyle changes that support overall health and fertility. 

Will I Need Specialized Care During Pregnancy? 

Women with PCOS or a high BMI may require specialized care during pregnancy to monitor and manage potential complications. There was a study that used a large group of patients and found that those who received integrative Chinese herbal medicine therapy had a significantly lower risk of developing type 2 diabetes compared to those who did not (Liao et al., 2019). The findings suggest that Chinese herbal medicine can be a valuable complementary treatment for managing long-term health risks associated with PCOS. Golden Gate Fertility Centre discusses how Traditional Chinese Medicine (TCM) can be integrated into the treatment of PCOS. TCM focuses on balancing the body’s Ying-Yang systems, using methods like acupuncture and herbal medicine to regulate menstrual cycles and improve fertility. This holistic approach can address the unique needs of women with PCOS or high BMI, helping to mitigate risks and support a healthier pregnancy journey. 

Specialized care during pregnancy involves frequent monitoring through regular check-ups to track blood pressure, blood sugar levels, and fetal growth. Nutritional counseling is provided to help maintain a healthy diet and appropriate weight gain. Early and regular screenings for gestational diabetes are essential to ensure a safe pregnancy. Additionally, if necessary, referrals to specialists such as endocrinologists or maternal-fetal medicine experts are made to address complex medical needs and ensure comprehensive care.