Polycystic ovary syndrome (PCOS) is the most common endocrinological disorder in women. It is one of the leading causes of infertility worldwide, affecting around 1 in 10 of women of reproductive age. Metformin has been used to treat the symptoms of PCOS, but many have wondered if it is really the best treatment path to take.
But first, what is PCOS?
PCOS is a metabolic disorder caused by hormonal imbalances, including too much male hormone (hyperandrogenemia), too much insulin (hyperinsulinemia), and hypersecretion of luteinizing hormone (LH).
Medical scientists have done extensive research on PCOS, and their focus has been on malfunctioning ovaries. Ovaries have three different types of cells: oocytes, granulosa cells, and theca cells. Oocytes divide within follicles to become an ovum or potentially fertilizable egg. Granulosa cells provide the physical support and microenvironment required for the developing oocyte. Theca cells make up the connective tissue surrounding the follicle, and help create ovarian follicles in a process called folliculogenesis.
Theca cells have a crucial role in fertility, because they help follicles mature enough to become fertilized. Theca cells are the last of the follicle to die. Once ovulation occurs, theca cells differentiate and form the corpus luteum. The corpus luteum is the little cave left by an oocyte that ovulates. The corpus luteum produces progesterone to maintain a pregnancy.
Theca cells are fundamental for follicular growth, providing all the androgens required by the developing follicles for conversion into estrogens by the granulosa cells. Theca cell function is enabled through the establishment of a vascular system, which provides communication with the hypothalamus throughout the reproductive cycle.
Most research on PCOS has focused on the role of theca cells. When theca cells become insulin resistant, they produce too much testosterone. Too much testosterone leads to the hyperandrogenism in polycystic ovary syndrome. Hyperandrogenism causes hirsutism, or male-like body and facial hair, loss of scalp hair, acne, midline weight gain, and the elevation of cholesterol and blood pressure.
Now, what role does metformin play in all of this?
Metformin was originally used to find out how much insulin resistance affects women with polycystic ovarian syndrome.
In women with PCOS, insulin resistance is caused by hyperinsulinemia, or too much insulin production by your pancreas. Too much insulin may increase testosterone production by interfering with communication between your hypothalamus, pituitary, and ovaries. Too much insulin also decreases circulating levels of sex hormone binding globulin (SHBG). SHBG helps bind testosterone to prevent hirsutism.
How can metformin help?
Women with PCOS are often infertile. Metformin can induce ovulation in non-obese women with PCOS. While metformin offers some advantages over other first-line treatments for anovulatory infertility such as clomiphene, it can have significant side effects, which I discuss at length in this video..
What many don’t realize is that metformin is a downstream medical treatment. Downstream medicine focuses on the treatment of symptoms, instead the root cause. Downstream medicine is problematic because it ignores the root cause, and the issue is never truly healed.
The hormonal irregularities of PCOS are centrally controlled by your hypothalamus. Supporting your hypothalamus can help reverse insulin resistance, and improve fertility in women with PCOS.
We discuss the problems women with PCOS face in our Hormone Support Group, which you can access through our free Hormone Reboot Training. If you’re interested in learning more about PCOS, metformin, and how you can balance your hormones naturally, I’d love it if you joined us.