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Polycystic
ovarian syndrome (PCOS) is a common cause of female
infertility. PCOS is characterized by elevated androgen
(male hormones) levels which manifest clinically as increased
body hair growth, a classic pear shaped body appearance,
lowering of the voice and other male characteristics. PCOS
patients also have ovaries covered with numerous residual
follicles.
Most PCOS
patients are also insulin resistant meaning their body
does not respond normally to a given dose of glucose. More
insulin is produced (hyperinsulinemia) to compensate for
this lowered response, which leads to further over production
of androgens by the ovaries. Chronically elevated androgens
lead to failed ovulation.
Metformin is used as a "first line"
drug to establish ovulation in PCOS patients. Metformin
is classified as an "insulin sensitizing drug"
meaning it increases the cells sensitivity to insulin. Increased
sensitivity of insulin corrects the hyperinsulinemia seen
in PCOS patients. Metformin has also been associated with
lower miscarriage rates, especially in PCOS patients.
Once hyperinsulinemia is corrected the
ovaries reduce their production of androgens and normal
ovulation can occur. Some specialists are prescribing metformin
"long term" even for patients who are not trying
to become pregnant. This is because the normalized insulin
levels reduce the risk for Type II diabetes, cardiovascular
disease, and other adverse events associated with hyperinsulinemia.
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