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If you have PCOS and find it hard to cope with insulin, two pills doctors use a lot are metformin and TZDs.
Both help your body use insulin in a better way, but they do this in their own way. Each pill has good and bad points you should know about.
- Metformin: This pill can help you lose weight. It makes your body more open to insulin and can help make your cycle normal. Some people feel sick to their stomach at first. Most times, this goes away after a while. Doctors pick metformin a lot, mostly for women who fight with weight or want to have a baby.
- TZDs: These pills do a better job cutting down male hormones like testosterone. That helps with things like extra hair. But, they can make you put on weight and keep extra water in your body. Because of this, they may not be best for women who worry about weight.
Fast Look at Both
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| PCOS Symptom | Metformin | TZDs |
|---|---|---|
| Weight Control | Lowers body fat | Can make you gain weight |
| Hormone Balance | Some help | Works well to drop male hormone |
| Period Cycle | Works well | Works well |
| Help Fertility | Helps you release eggs | Helps you release eggs |
| Bad Reactions | Belly pain, sick to stomach, rare acid build-up | More weight, water in body, weak bones |
What you pick will hinge on how you feel, what you want for your body, and what side effects you can stand. Metformin works well and is safe if you are with child or wish to shed some pounds. If you have trouble with your body’s hormones, the other drug might be the one for you, as it could help more. Speak with your doctor to know what will suit you best.
CoMICsLite Episode 33: Metformin for PCOS
Metformin: What It Does and Who It Helps
Metformin is one of the main drugs used for women who have PCOS. The FDA first approved it to treat type 2 diabetes, but doctors often use it in other ways, like to help with insulin trouble - a big reason for many PCOS problems.
How Metformin Works
Metformin helps your body use insulin better. It does this in three ways: it makes cells in your body (like muscle and fat) work better with insulin, it stops your liver from making too much sugar, and it slows down how much sugar your gut takes in. All of these things help lower how much insulin your body needs. This makes your ovaries make fewer male hormones. What does this mean? Your periods might come more often, you may lose less hair, and it helps with weight.
How Metformin Helps With PCOS
Because metformin fixes these things, you may notice big changes. Studies show metformin can help you ovulate, get pregnant, and have more regular periods. It can help you lose weight too (on average, people lost 2.47 points off their BMI) and lower male hormones, which helps with skin and hair trouble. It can also help with things like fat in your blood, which matters since women with PCOS have a greater chance of heart problems or diabetes.
Metformin Side Effects and Who Should Use It
The most common side effects with metformin are stomach upsets, such as nausea, diarrhea, and belly pain. Some women say it gives a funny taste in their mouth. The good news is these signs often get better after a little while, or you can start metformin slowly to help avoid them.
There is a rare, but really bad risk: lactic acidosis. This is most likely if you have kidney or liver issues. Doctors will check your kidneys before you start and sometimes check after to avoid trouble.
Metformin works best for women with PCOS who have weight problems, insulin troubles, or signs of poor health from sugar. It helps most if you haven't seen changes after eating better and moving more, or if your periods are not regular and you want to have a baby.
This drug is pretty safe. Many studies show only 7.64% of women (21 out of 275) stopped using metformin because of side effects. This makes metformin a good choice for many women with PCOS, especially if changing habits is not enough.
If you can't take ordinary metformin pills, there are new ways to use metformin, like a skin cream, which may make things a lot easier.
"I'm so glad I discovered Oana's metformin lotion! I used to struggle a lot with the side effects for oral metformin and this is a great alternative for me." – Carrie S., Oana Health patient
Oana Health offers options tailored to different needs, with oral metformin starting at $22 per month and topical formulations starting at $89 per month. These choices make it easier to find a solution that works for both your body and your budget.
Next, we’ll take a closer look at how TZDs compare and their role in managing PCOS.
TZDs: What They Do and Who Needs Them
Some women have a hard time with metformin or need something else for PCOS. TZDs, called thiazolidinediones, are another way. They make your body use insulin better. Some names for these drugs are pioglitazone and rosiglitazone. They are not like metformin. So, women who can’t use the usual drug may try these. Let’s look at what TZDs do, why they help, and what bad things can happen when taking them.
How TZDs Help
TZDs make your body’s fat and muscle cells work better with insulin. They turn on a part in your cells called PPAR-gamma, which helps cells take in sugar more. This is not what metformin does, because metformin works mostly on the liver and stomach. TZDs work on fat and muscle, cutting down swelling and making them deal with insulin more easily.
Why TZDs Are Good for PCOS
Studies show that TZDs help women with PCOS in other ways too. They don’t just make your body better with insulin. They have more good effects. TZDs can lower the sugar in your blood when you haven’t eaten and drop levels of insulin. They also cut key hormones in PCOS, like free testosterone and DHEA.
Doctors have seen that women who use TZDs often have more regular periods. For example, women using rosiglitazone are over five times more likely to see their periods get better, and for pioglitazone, the chance goes up even more. TZDs may help lower blood pressure and make other health signs better.
In one big study of women with different body sizes, TZDs helped lower insulin and blood sugar. These drops show how TZDs may help manage problems with insulin in PCOS.
Risks and Side Effects of TZDs
But TZDs are not perfect. They can bring problems. Many women have shown side effects like gaining weight and headaches. These may bother people wanting to lose weight, because metformin does not have these same problems.
There are more risks too. TZDs can make your body hold too much water. This can hurt your heart and make heart failure more likely. You could also break bones more easily with these drugs. So girls and women who are pregnant, want to be pregnant, or have heart or liver problems should not use TZDs. Doctors will check how your heart and liver are doing before you start and while you are on these drugs.
Doctors found that about nine out of one hundred women stop using TZDs. This is about the same number as for metformin. So if you can’t take metformin or your insulin issues are really bad, TZDs might work for you. But if keeping your weight in check is important, TZDs may not be the best choice, because you could gain weight from them.
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Metformin vs TZDs: A Simple Look
If you have PCOS, you may hear about two drugs: metformin and TZDs. Both can help, but in their own ways. Metformin helps your body use food better. TZDs help with hormones. Here’s a clear look at each.
Which Helps More With PCOS Problems
Both metformin and TZDs do a good job helping your body use sugar the right way. Studies do not show one is much better than the other when it comes to making your body need less insulin. But each drug helps with other PCOS problems in its own way.
For weight loss, metformin works best. In many studies with lots of women, those who took metformin lost more weight. Their BMI went down by about 2.5 points in just three months. This matters a lot since gaining weight is hard for many folks with PCOS.
For fixing high male hormones, TZDs help more. They drop levels of free testosterone and DHEA, which helps if your hormone levels are high.
For getting your period and ovulating, both drugs are helpful. Either one can help bring your periods back and help you get pregnant.
Both drugs help, but each shines for different problems. Talk to your doctor to see which is best for you.
| PCOS Sign | Metformin | TZDs |
|---|---|---|
| Weight Loss | Makes BMI drop | Can make weight go up |
| Hormone Level | Helps a bit | Better at lowering male hormones and DHEA |
| Periods | Makes cycles better | Makes cycles better too |
| Fertility | Helps eggs be made | Works just as well |
| Blood Sugar | Helps lower blood sugar | Helps blood sugar the same |
Side Effects Comparison
Metformin and TZDs do not give the same side effects, and that can change what you pick for your care.
Metformin can make your stomach feel bad. You may feel sick, have loose stool, or get cramps. Most times, this gets better if you start with a small dose and raise it little by little.
TZDs are not the same. They often make people gain weight and keep too much water in the body. This can make the heart work too hard, and in time, may raise the chance of bone breaks.
Still, people stop taking each drug at about the same rate. What you choose should fit what side effects you can stand and what is best for your health.
Which Treatment Is Right for You
Picking between metformin and TZDs is about what matters most to you and what side effects you can deal with.
Metformin may be better if you:
- Want to drop weight or keep from gaining more
- Are too heavy or have problems with sugar in your blood
- Want to have a child soon (metformin is often safer for women)
- Like to take a drug that seems to have less risk over many years
TZDs may be better if you:
- Cannot take metformin because it upsets your stomach
- Have a good weight but too much of one hormone
- Did not get better with just metformin
- Do not have heart or bone problems
Both together - using metformin and TZDs at the same time - may help if one alone is not enough. Studies show this can help more people with their problems, with only a few stopping the drugs - just 2.9% left early.
Getting PCOS Help Made Just for You
Dealing with PCOS takes care that fits you. What works for one woman may not work for another. Drugs like metformin or TZDs can help, but they can also have side effects. PCOS looks different for each woman. So, your plan should match your health, your life, and your goals.
What Can Change Your Plan
Many things shape what care you need:
- Age and body size: Women who weigh more may do well with metformin. It helps with weight. But TZDs can make you gain weight. So, they may not be best for all.
- Plans for kids: Are you hoping to get pregnant now or soon? Metformin is safer in this case. TZDs can’t be used when you want a baby, so they are skipped.
- Other health needs: Health issues matter. Bad kidneys? Skip metformin. Heart or bone concerns? TZDs may not be right. Your doctor will look at your health to pick the best drug.
- How you feel on these meds: Some women feel sick to their stomach with metformin. Some gain weight with TZDs and don’t want that. Can you deal with these problems day after day? That helps pick your long-term plan.
With online care, or telehealth, PCOS can get the care that fits you and your life.
How Oana Health Makes PCOS Care Simple
Online care changes how women get help for PCOS. It saves time and gives a care plan made for you. No more trips to doctors, long waits, or more lines at the drug store. Oana Health gives help straight to you at home.
It’s simple. You fill out a short online form with your health info and your worst symptoms. PCOS experts look at it and build a plan just for you. Your plan might have metformin or other drugs, maybe even a mix, based on what you need.
Oana Health has both metformin pills and metformin lotion. If pills make your stomach hurt, lotion lets you use metformin another way.
Prices are set to help more women get care. Pills start at $22 a month. The lotion is $43 a month. If you need two drugs, you can get metformin and spironolactone for $32 a month. No need to pick up meds; they come to you with free delivery. You get refills sent too, so you won’t miss your dose.
Oana Health gives more than meds. You can talk to your team any time. Want to change your dose or ask questions? You can. This keeps your care working just right and can change as you change.
One woman, Victoria A., told her story:
"Oana's telehealth service is fantastic! It's helped manage my insulin levels and reduce excess hair growth I was experiencing due to PCOS." - Victoria A., Oana Health Patient
This way of care helps you keep up with your treatment and see real changes in how you feel with PCOS. You do not get a basic plan; you get help that fits what you want and need. This makes your life better in real ways, and you feel it. The plan is just for you, so it works with your life and helps you stay on track with what matters.
Key Points to Remember
When you look at metformin and TZDs for PCOS, both can help with insulin trouble. Insulin trouble is a big reason for things like missed periods, not being able to get pregnant, and other health problems. Each drug works in its own way and has its own good and bad sides.
Studies say both medicines help with getting eggs from the ovaries, having babies, and making periods show up on time. Both do this about as well as the other. Their big differences are in how they deal with weight and the way they may give you side effects.
- Metformin: This drug helps people lose weight and is good for the heart. People who take it show a drop in BMI by about 2.47 kg/m² after three months. But, it might upset your stomach. You could feel sick, have loose poop, or cramps.
- TZDs: These drugs lower male hormones well. They help with things like too much hair or pimples. But they may cause you to gain weight and get headaches, which is not so good.
Picking one over the other depends on what matters most to you. If losing weight is the biggest thing for you, then metformin may work better. If stopping signs caused by male hormones matters more, then TZDs may be better.
Some people can take both drugs together. Using both might help more, like getting your period back faster than just using metformin. Still, using both could give you more side effects, so you need to be careful.
To pick the right treatment, you should talk with a doctor online. Services like Oana Health can help you from home. They have metformin you can take by mouth for $22 a month, cream for $43 a month, and packs with metformin and another drug for $32 a month.
Finding the best medicine for you and getting help online can make it easier to deal with PCOS. With care made just for you and help when you need it, fixing insulin problems and feeling better can be more simple.
