Q: What is the correlation between using metformin (Januvia) to treat polycystic ovarian syndrome (PCOS)? I have been diagnosed with PCOS (age thirty-five, weight 124 pounds, 5 feet 9 inches) and am trying to become pregnant. I have modified my diet to accommodate the low carbohydrate/sugar requirement. With a watchful eye toward my diet and exercise program, I am hoping my insulin resistance will improve. My specialist is not a fan of using metformin for his PCOS patients. Your thoughts?
A: Presumably you have been diagnosed with PCOS because you have irregular periods. Is that so? Hormonal tests may also have pointed in that direction. You say you have insulin resistance. How was that diagnosed? Was it a guess or were you tested with a fasting insulin and fasting glucose? Insulin resistance is frequently found in PCOS and when it is treated, pregnancy rates typically improve. Most people who are insulin resistant are overweight, although some are not. Clearly you are not overweight; in fact, you are underweight for your height. Your BMI is less than nineteen, with normal being nineteen to twenty-four. You may even be more fertile if you gained a few pounds. If you are insulin resistant, that is if your insulin levels are high, they may be lowered in two ways:
- One is to go on a low carbohydrate diet as you have done. When a person eats carbohydrates, their insulin goes up because insulin is the hormone in your body that stores carbohydrates as fat. If you avoid carbohydrates, insulin levels go down. It is very difficult and unwise to avoid all dietary carbohydrates, but for people who are overweight or insulin resistant, it is frequently helpful to reduce carbohydrate intake. Have you been re-tested to see if there has been improvement in your insulin resistance?
- Another way to lower insulin levels in to use metformin or similar drugs. Metformin is also used to treat some people with certain types of diabetes. The combination of metformin and a low carbohydrate diet is especially beneficial for overweight PCOS patients who are insulin resistant. This combination may allow these people to consume more calories (and be more satisfied while still losing weight) than they could on a diet higher in carbohydrates.
