Tag Archives: medication

Metformin: basic information

18 Mar

Many PCOS patients are prescribed Metformin for the treatment of their condition. It can be a bit confusing, because it is only FDA approved for treatment of diabetes; however, there are a lot of good reasons for using this drug to treat PCOS. Here’s a general overview of some things you should know.

How It Works

Metformin improves your body’s sensitivity to insulin. If you read my post about insulin resistance, you’ll remember that an insulin resistant person produces a lot of insulin, and her body is not very good at recognizing and using it to control blood sugar. Metformin improves the body’s ability to do this; it resensitizes the cells to insulin, so that your body doesn’t have to produce as much.

What It Does
From your perspective, you might see the following results from Metformin:
* Lower risk of developing diabetes.
* Easier weight loss (this varies from woman to woman, but many feel that Metformin makes it easier to drop pounds).
* Drop in testosterone production–this is directly related to the drop in insulin production. This can also mean less hirsutism, acne, and hair loss.
* Improved menstrual cycle regularity. Many women on Metformin have more consistent or frequent cycles. That is why it is often prescribed for women who are trying to get pregnant. (I took Met when I was trying to conceive my second child, and it did regulate my cycle very well.)
* Reduced risk of miscarriage. This is why many reproductive endocrinologists recommend that PCOS patients continue to take Metformin through the 12th week of pregnancy or later.

Side Effects
Metformin can have some major side effects for some women. These include GI symptoms (nausea, diarrhea), which can be bothersome, but not usually dangerous, at least in the short term (see below for suggestions on minimizing these problems). However, Metformin is also associated with liver and kidney problems; usually, this won’t be an issue for you unless you have a liver or kidney function problem already.

Metformin can also cause (or contribute to) a problem called lactic acidosis. This is rare (3 in 100,000 Metformin users), but it is a serious problem, so you should be aware of the symptoms: weakness, slow pulse, muscle pain, deeper and more labored breathing, and sleepiness. This is more common if you have liver/kidney problems, dehydration, diabetes, or a great deal of chronic stress. It is very important that you NOT take Metformin while fasting (for example, before a medical procedure) or if you are dehydrated, for this reason.

How to Minimize Side Effects
If you do have unpleasant GI symptoms while taking this medicine, there are a few things you can do to try to make them less severe. Make sure that you eat when you take your medication; break up your dose over the course of the day; and, at least at first, avoid very fibrous foods such as salads. Some people also find that the name brand (Glucophage) causes them fewer side effects.

The Bottom Line
Should you take Metformin? That’s a question you’ll want to discuss with your doctor. It’s worth considering, though, if you have many symptoms of insulin resistance. The side effects (which, by the way, I never experienced) are manageable for most people who use it, and it may be protective against diabetes over the long term.

Metformin for low milk supply in PCOS mothers

3 Jul

Lisa Marasco–the ICBLC who is possibly the first researcher to examine the role of PCOS in low milk supply–has found evidence that Metformin can help with low milk supply in mothers with PCOS. The La Leche League has an excellent article by Marasco available on their web site (Marasco is an LLLI leader, as well as a lactation consultant).

Marasco suggests that anecdotal evidence shows a boost in milk production for low-supply moms with PCOS. She acknowledges that large-scale studies and high-quality research on this do not yet exist; however, in the absence of other good options, it may be worth trying. Marasco advocates using Metformin throughout the pregnancy and during breastfeeding.

Thomas Hale, the leading authority on the safety of drugs in breastfeeding mothers, has studied Metformin and concluded that it is quite safe. His assessment can be found here (warning: it’s pretty technical). Essentially, Hale found that the levels of Metformin in breastmilk were low, and that no adverse effects on the infants were reported.

He does point out, however, that “since metformin is largely excreted via the kidneys, particular caution should be exercised where the infant renal function is low or compromised (e.g. in premature neonates, or in rare cases of renal failure).” This doesn’t mean that no breastfeeding mother of a preemie should take Metformin; rather, it means that your doctor should consult with your child’s pediatrician and make the decision carefully. Since breastfeeding is beneficial, especially for premature babies, being able to produce more milk may benefit the infant enough to be worth the risk. Kidney function should be carefully monitored, though.

You may also be interested in this study, which examined infants whose mothers took Metformin over the course of their first six months of life. No differences in development or illnesses were found.

Finally, this page from Kellymom has a good list of links about PCOS and breastfeeding, including links to info about Metformin. (How much do I love Kellymom? A whole lot, that’s how much.)

Ultimately, my feeling on this matter is that it’s worth a shot. Metformin, which is a first-line treatment for PCOS, has a lot of benefits for PCOS sufferers; it can improve regularity of cycles and reduce other symptoms. I find it plausible that Met might make some differences to the hormonal balance that promote milk supply. Of course, not all patients find Metformin easy to tolerate; it often has significant GI side effects. Talk to your doctor about prescribing you the name brand (Glucophage) if that is true for you and adjusting your diet doesn’t help. Some PCOS ladies have reported that the generic has more side effects for them than the name brand.

That said, I took Met before I got pregnant with my son (and for the first trimester), and I had almost zero side effects. It regulated my cycle almost immediately and I conceived my son in the second month of trying. As a result, I’m a believer in Met’s ability to affect hormones for the better, which means that if I were going to have more children, I’d be taking it throughout the pregnancy and while breastfeeding.

seven steps to help you deal with anxiety

29 Jun

If you have anxiety, there are many options open to you to improve your life! Here are my recommendations for the first things you might try.

1) Make sure it’s anxiety.
See your doctor to rule out the possibility that your symptoms are caused by something else. Some of the manifestations of anxiety are very similar to other health problems, and a physical is a good idea. Take a list of your symptoms to the appointment, and tell the doctor that you think it may be an anxiety problem but that you’d like some help differentiating between that and some other health problem.

2) Write down your experiences.
If you and your doctor think that anxiety is the problem, the next thing I recommend is a bit complicated, but worth it: keep a journal for a week that records your symptoms with the date, time, and any comments you have. Use the journal to record, as well, the following things: how much sleep did you get? How much exercise? What did you eat and drink? Did you have any major stressful events?

3) Look for patterns.
Once you have a week’s worth of observations to examine, sit down with your journal and look for patterns. Are you very tense on days when you haven’t gotten enough sleep? Do you have a panic attack before every big work meeting? These correlations can help you find the best treatments for you.

4) Evaluate your lifestyle. Things that can reduce anxiety include getting enough sleep (easier said than done for many of us); getting plenty of exercise (also great for fighting depression); cutting out caffeine; and reducing your intake of sugar and other simple carbs. You will have to decide which of these changes you are willing and able to make. It is not always feasible to overhaul everything in your lifestyle, especially all at once. But making a few changes (such as switching to decaf coffee or iced tea, adding a walk to your lunchtime routine, or doing a bit of gardening every night for exercise and relaxation) can help, too. It isn’t all or nothing.

5) Learn a few simple relaxation techniques
. Deep breathing can help, and it’s easy to learn. Anxieties.com has excellent information about this, so I won’t try to reinvent the wheel by listing them here–but deep breathing, muscle relaxation, and other techniques can help a lot, even if it doesn’t seem likely to you right now. Give it a try and see if it helps you!

6) Counseling can also be useful. Depending on what your brain is saying to you when you’re feeling anxious, learning different kinds of self-talk can help a lot. Cognitive-behavioral therapy, or CBT, is great for this. You also might find that counseling can help you resolve whatever issue is causing you the stress in the first place (a problematic relationship, a bad work situation…whatever it is that’s leading you to feel so anxious, if you suspect that your anxiety is situational).

7) Finally, medication can help. There are two basic ways of medicating anxiety. Some people do both.

The first is the use of antidepressant medication, which often also has an anti-anxiety effect. You may have to try several before you find one that works for you, and because it takes a while to see results, this period can be frustrating. Popular choices for medicating anxiety include Zoloft, Lexapro, and Paxil; some other antidepressants, such as Wellbutrin, are less likely to help with anxiety. That said, Wellbutrin is what I take and it does help me a lot, so patients vary in this respect!

The second class of medications for this problem is the benzodiazepines. (Some of the newer drugs in this group are not actually benzos; however, I’m not quite sure what else to call them.) These include Xanax, Klonopin, Valium. There are definite up sides to using these drugs: they have measurable, quick, and reliable effects on anxiety. Most people who take them will see a reduction in anxiety. These effects take only a half an hour to an hour to appear. There are also some down sides, though–notably the fact that they can be habit-forming and that they can be too sedating, leading to excessive sleepiness, uncoordination, and inability to focus. (Some people take them at night to help initiate sleep, which cuts back on the sleepiness problem, but may exacerbate the addiction problem.)

Benzodiazepines can also be dangerous when combined with alcohol or other prescription drugs (including painkillers and sleeping pills). Be sure that your doctor knows everything else that you are taking, and avoid alcohol when you’re using them (or at least limit it to minimal amounts).

Many studies have shown that benzos lose their effectiveness when used routinely.

The bottom line on anti-anxiety medications is that antidepressants are safer; these can be excellent choices. It takes some time for these medications to work, though. In my opinion, there are some situations where benzodiazepines are very useful: to have on hand for major stressful events that exacerbate your anxiety disorder; to use when needed until your antidepressants start to kick in; or to help augment your antidepressants during a panic attack if you have occasional panic attacks. I do not think that taking them daily is a good idea–if nothing else, they will lose effectiveness over time, and then you won’t have that in your toolkit in case you have a major anxiety-causing event.