Top 5 Metformin Side Effects for Women with PCOS

Metformin Side Effects for PCOS

Metformin side effects for PCOS need to be understood as potential side effects of metformin may impact a woman’s chances of getting pregnant. What kind of metformin side effects can I expect to see if I have PCOS? When sufferers of Polycystic Ovarian Syndrome endeavor to rebel against the disease that has greatly compromised their reproductive potential, many turn to metformin for PCOS.

While Metformin was originally conceived to help diabetes patients better manage their blood sugar levels, the properties that help these people also do a number on the destructive capabilities of Polycystic Ovarian Syndrome (a).

Metformin decreases the destructive effects that androgen and insulin has on the ovaries of PCOS patients by reducing the production of the former and increasing the body’s sensitivity to the latter (1).

It accomplishes this by reducing the production of glucose in the liver via gluconeogenesis, thereby reducing the aggressive insulin response in the bodies of PCOS patients that then gives rise to androgen production (b).

With any compound that has been shown to work well against any given medical condition, it is always important to keep in mind the potential side effects, which are factors that are often swept by the wayside when folks clamor over the latest wonder drug.

Similarly, those using metformin for PCOS need to be armed with the knowledge of the symptoms that mark the potential side effects that they might experience, which ones are relatively harmless, and most important of all, the ones that denote a life-threatening reaction that requires immediate medical attention.

While incidents of this magnitude are typically rare, it is vital that you are aware nonetheless, as it is better to switch to a PCOS treatment that is more suitable for you than to pin your hopes and dreams to a bottle of pills that might risk your health.

metformin side effects
metformin side effects

Now that we scared you a bit…

It’s important to note that all medicines have side effects, whether they are located behind your pharmacist’s counter, or if they are readily available in the aisles of your local drugstore.  You might be surprised to know that Tylenol (a common painkiller), when taken in doses that are slightly heavier than recommended, or normal doses that are had with a glass of wine can potentially lead to liver failure and death (2).

In the same manner, it’s important to be aware of how metformin for PCOS affects your body. Most can be lived with without too much hardship, as the benefits of taking this drug far outweigh the inconveniences.

On the other hand, others may indicate that this drug might not be right for you, and a few rare side effects may be signaling that you are in a life threatening state.

In this article, we feel talk about the five most common side effects that the average metformin recipient might encounter, followed by the much less common but more troublesome symptoms that you should watch out for.

Before we get to the list, we want to be clear that we are just posting this article for informational purposes. Reading this does not replace your pharmacist, or your doctor. Talk to them about the effects of taking metformin for PCOS, and about what you are experiencing as you proceed through your treatment cycle.

With that proviso out of the way, let’s get to the list:

UPDATE MAY 2016: While this article originally addressed the top five metformin side effects that patients might expect to encounter during their treatment protocol with this drug, they aren’t the only ones out there.

As of this month, we have added more information to this article to give you a more complete picture of the effects that one could experience while taking this drug.

This way, you won’t be caught by surprise by conditions that metformin sometimes causes, and knowing this, you will be able to adjust your life to accommodate them, or in rare cases, you might decide that this treatment isn’t right for you.

No harm, no foul, as there are a variety of ways you can tame PCOS and improve the viability of your reproductive system that don’t involve this effective but imperfect prescription drug.

1) Periods of nausea and/or diarrhea

Because metformin works by increasing the efficiency of insulin in the body (3) (thereby reducing the amount of free insulin that would otherwise terrorize your ovaries), sometimes it can do its job a bit too well.

This can occasionally lead to hypoglycemia if you don’t eat enough while on the drug, and since one of the more palpable symptoms of it is nausea, it is also a common side effect of metformin use as a result (4).

Increases of serotonin levels during the initial stages of treatment also lead to the onset of nausea and diarrhea in patients taking metformin for PCOS, put these symptoms usually abate a few weeks into the treatment cycle (5).

These two side effects are the most common complaints of patients that take metformin, as diarrhea had been shown to develop in over half of participants in a clinical study, and nausea and vomiting occurred with a quarter of those being studied (c).

2) Reduced appetite

Not long after one begins using metformin, they begin to note that they don’t have the urge to reach for that bag of chips like they used to.  They may also have a hard time finishing what’s on their plate as well, making it a concerning state of affairs for overall nutrition.

Because metformin helps insulin does its job at a much higher efficiency, the cells that had been previously starved for food under the body’s prior status of being insulin resistant are now having their needs satisfied, leading to a need for food that is drastically lower than what the patient had required before (6).

As long as you are eating nutrient-dense food, this symptom should not be too concerning overall, as it will actually lead to beneficial weight loss for many suffering from PCOS related obesity.

3) Gas pains / increased flatulence

While metformin does wonders for insulin efficiency, it also tends to reduce the amount of insulin available in your system. Because of this, unabsorbed glucose can end up “fermenting” in your system, producing painful gas at times. According to the same study referenced in #1, intestinal gas was the third most reported symptom in that particular clinical study, with 12% of participants suffering from gas pains and excessive flatulence (d).

4) A metallic taste in your mouth

Many drugs, metformin chief among them, have significant effects on the hormone levels in your body.  While these manipulations achieve desirable effects, they also can effect things like how to perceive the taste of things (7). And so it is with metformin, with many recipients reporting that the insides of their mouth taste more like a roll of quarters than the neutral fleshy feel that is normally present. Over time, the body will grow used to the drug, so this side effect should abate over time. In order to get used to the taste of the drug in the short term, take it with a large glass of water to help the pill clear your oral cavity faster.

5) A decrease in Vitamin B12 levels

This side effect is less noticeable, as the drop in Vitamin B12 levels that this drug causes in patients taking metformin for PCOS is often asymptomatic for many (8).  However, low levels of this vitamin can cause a metallic taste in the mouth much like the hormone changes in the previous point can, and other signs such as lightheadness, bleeding gums and a sore tongue can also indicate a deficiency that may be linked to metformin use (9). A vitamin B12 deficiency is also known to increase the likelihood of depression and irritability, so if you have been experiencing some blue moods since beginning a regimen of taking metformin, it is certainly possible that this drug is to blame (e).

Speak with your doctor as soon as possible if you experience these side effects

If you break out in hives or a rash after taking metformin, it could be a rare instance of the drug causing an allergic reaction in your body. Whether it is linked to this or not, it is important that a doctor gets to the bottom of what is going on to avoid this serious health issue from continuing (10).

Additional metformin side effects to watch for:

In the months since the posting of this article, we have done additional background research into other side effects of metformin that may occur during a typical treatment program.

Though they may not pose an immediate threat to your health, those experiencing the following conditions shortly after beginning treatment with metformin should make an appointment with their doctor to reevaluate its trajectory:

1) Stomach / Abdominal Discomfort

It is highly recommended that those on metformin take their medication during or after a meal in order to avoid the pain that can sometimes occur when taking this drug.

However, if your upset stomach or sore abdominal muscles are accompanied by difficulty breathing, cramping and hypothermia, call 911 and get to an emergency room as soon as possible, as these are all symptoms of lactic acidosis, a potentially lethal condition.

2) Coughing / Hoarseness

Find yourself literally drying up in conversation ever since you began taking Metformin? It’s not your imagination, as one of the side effects of this blood sugar control drug might have allergic effect in some people (f).

To see if this is the case with you, or if another drug that you might be on is the actual culprit, it’s best to make an appointment your doctor and discuss  the development of a dry cough since the beginning of your metformin regimen.

3) Fever / Chills

Recently started taking metformin and have come down with a case of the chills and/or fever? It could be that flu or cold that’s been going around, but if it keeps occurring soon after you take your medication, you’ll want  to see the physician that prescribed your dosage.

Fever and chills also accompany the dangerous condition of lactic acidosis, so if you have abdominal pain, difficulty breathing, and persistent cramps along with your fever and/or chills, get yourself to outpatients as quickly as possible.

4) Back pain

A particularly unpleasant side effect that can occur in certain patients Is the development of back pain.  Debilitating at times, it may be the result of interactions of the drug with individual aspects of the patient’s body.

The buildup of lactic acid may be behind it, so be sure to consult a medical professional if you develop pain in any of the muscles that compose your back.

5) Difficulty / painful urination

Having trouble passing urine, or has it become such an ordeal with a burning sensation that you dread your nightly trip to the bathroom?

If you are suffering these symptoms over a respectable period of time, mention it on your next check up with your doctor, especially if it is coming out cloudy or with blood.

6) Sleepiness / Drowsiness

Find yourself struggling to get to your normal bedtime shortly after starting your metformin regimen? You’re not alone, as this is another common side effect that has been uncovered recently.  

The reason for this is that metformin acts to deplete vitamin B12, a compound that plays a key role in the energy creation and transport mechanisms throughout the body, That fact that it inhibits its ability to perform its duty makes its one of the more inconvenient metformin side effects. The end result of this is that it leaves you tired far sooner than you would ever expect (g), catching many active people by surprise.

To counteract this effect,  be sure to get on a B multivitamin regimen that will mirror your doses of metformin In order to combat the reductions in natural B12 levels that will occur during  treatment. If extreme tiredness continues after starting a regular schedule of B vitamin usage, consult your doctor about your issues with  chronic fatigue.

Dial 911 immediately if…

If an allergic reaction emerges shortly after metformin use that gives you trouble with breathing properly, and it is causing your face, lips, tongue, or throat to swell, you have a genuine medical emergency on your hands. Dial 911 without delay.

The same follows if you begin displaying symptoms of lactic acidosis, which is a rare occurrence (the odds of developing this dangerous condition is 33,000:1) when taking metformin for PCOS, but it is certainly possible for some. It includes signs like weakness (from being brought into a hypoglycemic state by Metformin), rapid breathing, profuse sweating, clammy skin, and sweet breath, as well as belly pain, nausea or vomiting, and/or confusion.

It is caused in a scenario where the body has issues removing metformin from the circulatory system in an expeditious fashion. In the event that the liver and the kidneys have a difficult time and removing the accumulated lactic acid from the system caused due to aggressive metformin enhanced anaerobic metabolism, lactic acidosis can be the dangerous end result (h).

If you display any signs of this condition, get to the hospital as soon as possible; 50% of all lactic acidosis cases end in the death of the patient (11), making it one of the most dreaded of all metformin side effects.

Be aware of potential complications

As you are well aware by now, lactic acidosis is one of the biggest concerns that one should worry about when you are taking this drug, as it is by far the most serious of the side effects of metformin. However, there are certain pre-existing conditions that make the development of this state more likely than in other individuals. If:

1) you have kidney or liver disease already;

2) you have had surgery recently;

3) you are currently battling an infection;

4) you are experiencing conditions that are causing circulation problems (such as the aftermath of a recent heart attack);

5) you are a heavy drinker;     

6) you are in a dehydrated state

7) you very recently went in for X-rays and as a result, You still have the injectable iodine drug  in your system that Makes seeing body structures much easier for the X-ray tech.   

In all of these cases, your body will be in a compromised state that will make handling the negative effects of the drug much tougher (i). Don’t stay silent; advise your doctor if any of these conditions apply to you, as the formation of lactic acidosis is aided by these circumstances.

With respect to #5 on the list above, even if you aren’t a heavy drinker, avoiding binge drinking sessions while on metformin is essential, as even occasional exposure to alcohol can put you at risk for developing lactic acidosis (j).

If you are sick or recovering from an injury/surgery, your body loses the ability to control blood sugar to the point where the development of metformin side effects would be a danger to your health, hence the reason for the prohibitions on taking this drug while having a viral or bacterial infection, or in the days and weeks after a major operation (k).

Those that have a kidney condition may not necessarily be disqualified from taking metformin, but they need to closely coordinate its use with their doctor, who will monitor whether the interaction of this drug with the patient’s kidneys is posing a problem. If it is, then this treatment regimen will have to be suspended to ensure the safety of the patient, as the side effects of metformin will pose too much of a risk in this case (l).

Patients that have a liver condition will also have to have the level of their organ’s impairment assessed by a specialist. Those with severely limited function in the liver should not take this drug due to the real risk of life-threatening metformin side effects manifesting in the absence of effective metabolization of this compound.

If the patient has only a moderate reduction in their ability to metabolize free floating metformin, then treatment can proceed with close monitoring from their physician (m).

What you need to tell your doctor before heading in for your first appointment

You might be convinced that metformin is for you, and depending on your circumstances, it might do a world of good for your overall health and for improving the climate within your body for a potential pregnancy.

However, it is vital that you divulge any and all information to your doctor that might suggest that complications could occur if you were to begin a regimen of this drug tomorrow.

Come clean about any pre-existing medical conditions or allergies that you currently have, As well as any recent illnesses, injuries, or surgeries that you have had.  

All of these factors will have an impact on determining whether starting a metformin regimen is the best idea for you right now, so be honest when you are speaking with your physician, as not developing life threatening conditions as a result of aggressive metformin side effects is more important than clearing up your PCOS tomorrow.     

Stick to doctor prescribed dosages

Despite what your mind might be telling you, increasing your dosage will not necessarily improve your blood sugar situation.  

Indeed, studies have shown little additional benefit from the maximum advised dosage of 2,000 mg (r). Going Beyond this amount will not just yield you no improved functionality from the drug, but it might put you In serious danger of having an overdose.

Lactic acidosis is a rare serious side effect of normal use of metformin, but in the case of an overdose, the development of this condition is the leading mechanism behind those that are killed by taking this drug in too great a dosage (n).

Listen to your doctors regarding use of metformin; they spent over 10 years in medical school for a reason!

A word of caution for breastfeeding mothers

While present studies show that there are no discernible negative effects with respect to metformin and breastfeeding infants, it has been established that metformin does indeed leech over into the breast milk of mothers (o).  

At this time, the research has not suggested that this is a problem, but those not wishing to expose their children to this drug should know that the act of breastfeeding them while on metformin will do just this.

In conclusion…

Overall, the more serious side effects discussed at the end are very rare, and the common side effects, while annoying, are far overshadowed by the massive benefits can bring PCOS patients looking to control their weight, and/or get pregnant. What’s more, those that suffer from high insulin levels that start a regime of Metformin have been shown to have a decreased risk of developing Type II diabetes, so if one can overcome the drawbacks of usage, very real lifestyle gains can be realized through the use of this drug (u).

The side effects may be particularly noticeable at the start of treatment, but they tend to fade away in the following weeks as your body gets acclimatized to the drug’s effects. Be sure to go slow in the beginning of any treatment program, starting with a very low dosage relative to the eventual maximum recommended by the manufacturer. Working in close coordination with the doctor that drew up your prescription, gradually increase the dose over the course of weeks and months. Follow directions to the letter; do not break apart, chew or crush your tablets, as this can impact the efficacy of treatment and leave you with a very nasty taste in your mouth. Any decision to alter or halt treatment should be initiated by your doctor; keep them abreast of your side effects, and if they fail to abate, they can put you on drugs that might be a better fit, or alter your dosage in an attempt to alleviate the symptoms.

When dealing with synthetic compounds that have the potential to do untold harm, it is always best to leave these decisions to the professionals.

Taking everything into consideration, responsible use of Metformin has the potential to transform the lives of females that are suffering from the deleterious effects of Polycystic Ovarian Syndrome. So long as you take stock of the side effects that you are suffering, take appropriate action to alleviate any discomfort, and monitor dosage so that excessive amounts of the drug does not put you at risk for developing lactic acidosis, its effects will result in a net positive gain for your life.





Fertility Chef

Fertility Chef provides online PCOS diet & nutrition resources for women. Learn what a PCOS diet is & how it works.

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