If you struggle with polycystic ovary syndrome (PCOS), you have probably tried everything imaginable to help manage your symptoms. But what if an effective treatment for PCOS was already widely available, without any major side effects? It turns out that a decades-old diabetes medication has quietly emerged as a promising treatment for women with PCOS and other "off-label" conditions. 

So, what is metformin, exactly, and is it truly a miracle treatment option for PCOS? Let’s discuss. 

What is metformin?

Metformin is no new kid on the block: it has been used as a first-line treatment for type-2 diabetes since the 1950s and is considered by many to be a “wonder drug” for its wide range of benefits without the debilitating side effects. Metformin helps your body utilize insulin, improving your blood sugar over time. Most people generally tolerate it well, but others may experience symptoms such as nausea, diarrhea, stomach aches, and loss of appetite. Still, for most, the benefits of the medication outweigh any potential negative side effects. 

Although metformin was originally developed to treat type-2 diabetes, many doctors prescribe metformin to treat pre-diabetes, gestational diabetes, PCOS, and weight gain from anti-psychotic medications like risperidone. Beyond that, metformin is currently being studied for its potential uses to support cardiovascular health and lower the risk for certain cancers. How amazing is that? 

So, can you get a metformin prescription for PCOS without diabetes? 

Doctors are allowed to prescribe medications for purposes other than what they are approved for by the FDA; it's called “off-label” use. And because of metformin's safety, effectiveness, and the promising research to support its broader use, metformin is often prescribed off-label by providers. 

One of the most common off-label uses for metformin is to treat insulin-resistant PCOS, a common condition (and often, a precursor to type-2 diabetes) that can cause irregular or absent periods. For women with PCOS, metformin can be prescribed to help regulate ovulation, reduce androgen levels, improve insulin resistance, and aid in weight loss when taken in conjunction with proper nutrition and adequate exercise. In fact, studies have found that up to 90% of women resumed regular menstruation within 6 months of starting metformin. 

For women who are pregnant, metformin is considered a safe and effective treatment for gestational diabetes, as it lowers blood sugar and improves insulin sensitivity. In pregnant women with PCOS, metformin has even been found to lower the risk of miscarriage during early pregnancy, without risk to fetal growth and development. 

Does metformin cause weight loss? 

Many companies have started offering metformin as an alternative to semaglutides (think, Ozempic) because it can help support weight loss. 

According to one study in the journal Experimental and Clinical Diabetes and Endocrinology, metformin was specifically useful for weight loss in patients with insulin resistance and insulin sensitivity. Over six months, study participants taking 2,500mg of metformin lost, on average, 5-6% of their body weight, compared to .8 to 3% of the control group. In long-term studies, compared to a baseline control group, patients appeared to maintain their weight loss over 15 years after starting metformin. 

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Although it's not officially approved as a weight loss drug, your doctor might prescribe metformin to support weight loss if you have a BMI of 30 or higher, are on an anti-psychotic medication, or have insulin resistance. Still, the medication should not be used as a substitute for a nutritious diet and regular movement.

Is metformin right for you?

Miracle drug or not, metformin has been proven to effectively treat various health conditions beyond type-2 diabetes, with few notable side effects. If you suspect that you may have insulin-resistant PCOS and are interested in learning about, talk to your doctor about metformin. You never know; it might open up a larger conversation about the best next steps for you and your health! 

Erin Pettis is a content strategist, freelance writer, and women’s health advocate. She lives in New York City and holds an MBA from NYU’s Stern School of Business.