Diabetic
Medication
for PCOS or Infertility
General
Some diabetic medicines work by increasing the
sensitivity of the body to insulin. The use in PCOS (polycystic ovarian
syndrome) or infertility is "off-label" and is currently being investigated.
"Off-label" means that although it is not approved for marketing for PCOS or
infertility, we can use it.
These have the ability to correct hormone function in
certain women. These can also decrease hair growth, lower abnormal hormone
levels and increase the chance of ovulation. The increase in ovulation can
occur without other medications. But, at other time, Clomid or other
medication may still be required.
Glucophage (Metformin®) is the most studied of the medications
available. But rosiglitazone (Avandia®) and
pioglitazone (Actos®) may have fewer side side effects in some women.
Use of two of these in combination can also decrease side effects.
The medication should be stopped for some x-rays and for
surgery. The main side effects of Glucophage are nausea, vomiting, diarrhea,
bloating and abdominal cramping. In women with kidney disease, liver disease,
pancreatitis, circulatory problems or infection, other metabolic problems can
occur. Patients with alcohol related pancreatic or liver damage have died on
these medications.
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Alternative Treatment
Other treatment can include hormonal withdrawal for
control of bleeding, birth control pills for hair growth or control of bleeding,
other medication for excess hair,
clomiphene or other ovulatory agents for
fertility, in vitro fertilization, weight reduction clinics and surgical
procedures. The choice of these is dependent upon the problems to be treated
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Dosage
Metformin® (glucophage) is started
at one 500 mg tablet a day. The dose is increased to twice a day the
second week and three times a day the third week. Three a day (1,500 mg a day)
is continued for 4 weeks and the blood tests are repeated. If the insulin
level is normal, this dose (1,500 mg a day) is continued and decisions are made
regarding clomiphene and/or other medications.
If the insulin level is abnormal, the dose is increased to 850 mg twice a day
for one week and then three times a day. Three a day (2,550 mg a day) is
continued for 4 weeks and then the tests are repeated. If the insulin level is
normal, this dose (2,550 mg a day) is continued and decisions made regarding
clomiphene and/or other medications.
If the insulin level is still abnormal, additional medication or further
evaluation is needed. If there are side effects or abnormal biochemical testing,
the medication may need to be changed or stopped.
Avandia® (rosiglitazone) is started
at 2 mg daily and increased to 2 mg twice a day. Avandia is increased at 4 week
intervals if fasting blood insulin levels are still high. This can be increased
to 8 mg daily. If Avandia is used in combination, it is increased up to 4 mg
daily.
Actos® (pioglitazone) is started at
15 mg daily and can be increased to a total dose of 45 mg daily. Actos is
increased at 4 week intervals if fasting blood insulin levels are still high. If
Actos is used in combination, it is used at up to 30 mg daily.
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Blood Tests
Blood tests are done before starting the medication and
then every 4 weeks. The tests include liver function, kidney function, diabetes
and male like hormones. If any of these are abnormal, they are rechecked while
on medication to see if they improve.
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Insurance Coverage
Insurance
companies may not cover the "off-label" use of medication or the testing used to
monitor this medication. If you want to know if your insurance company is going
to cover this, you need to get written clarification.
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