QuestionHello. I am actually writing this for my daughter, she lives near Palm Springs, CA, on a marine military base. About 2 months ago, her dr told her she had PCOS, and put her on Metformin, 500 mg twice a day. Today, she had an appt with an ob/gyn, that her regular dr sent her to. The ob/gyn looked at her lab work,etc, and said you do not have PCOS, your hormones are normal. He told her to lose some weight, (she weighs 172 lbs, and is only 5' 2")
and then changed her Metformin to 3000 mg a day.He said come back in 6 months. She had a second term miscarriage of twins 2 years ago, so she is afraid of that happening again. Is it normal to take Metformin if you do not have PCOS? Just want to understand this. I realize you cannot diagnose, we would just like to be more informed. Thank you, Krista
AnswerHello Krista from the U.S.,
There is a tremendous amount of misinformation out there, even among Physicians. Many family practice physicians and OB/GYN physicians have embraced Metformin as a treatment for PCOS, because of the lack of understanding of the exact cause of PCOS, but not all PCOS patients need metformin. In approximately 50% of patients, there is the finding of an elevated insulin level (insulin resistance). Metformin is used to reduce the insulin level. In these patients, some will respond to the Metformin by having regular ovulatory menstrual cycles. However, not all respond. Based on this, many primary care physicians think/believe that metformin is indicated in all PCOS patients. That is completely wrong. The patient has to have the problem first (insulin resistance), and only those patients should receive Metformin. Normal patients should not! In addition, the correct dose is 1500-2000 mg per day (5oo mg three times to four times per day).
The second flaw with your doctor's is the thinking that "hormone levels" prove or disprove PCOS. PCOS is a clinical diagnosis i.e. you just have to have one of the features of PCOD to make the diagnosis. It is NOT a laboratory diagnosis. There are many different subsets of PCO and not all patients have ALL the features. The traditional PCOS patient is obese, has facial hair, reduced voice, irregular or absent menses, infertility, elevated insulin levels and diabetes, and an elevated LH/FSH hormone ratio. But some patients only have one or two of these features and they are PCOD nonetheless. There are PCOD patients that have normal hormone levels.
My recommendation to your doctor is to see a fertility specialist. She should not be getting treatment from primary care docs that lack the knowledge for her case. This is not a military doctor problem, as I am an ex-military doc, but a problem wil docs all over the country. It is due to doctors trying to do more than they really should. It is particularly a problem with Family practice docs (the do-all and be-all doctor).
If your daughter is trying to become pregnant again, she needs to undergo the proper fertility treatment.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com and twitter with me at @montereybayivf.
