(When I first imagined writing all this out, I thought I'd do it in one, maybe two posts at the most. I guess I had more to say about it than I realized.)
I'm going to step up on my soap box for just a moment. After pretty exhaustive research, it is my personal and professional opinion that all women with PCOS should be on metformin. It's cheap, it has very few potential long-term side-effects, and it's effective. It increases your chances of getting pregnant, increases your chances of staying pregnant, increases your chances of successful breastfeeding, decreases your risk for diabetes- both gestational and Type II, decreases your risk of many kinds of cancer. It may not be a silver bullet, but it sure helps to level the playing field. And yes, the short-term side-effects suck and it's no fun to have to take a pill or three every day forever, but, I think it's worth it.
And so, I started taking metformin. In my research, I had discovered that if metformin is going to help regulate your period, it will most likely do so in the first six months. My plan was to do just metformin for the first six months to see if my cycles would straighten out and if I would ovulate on my own. Please forgive my memory on this one, but I had also read that if you ovulated later than day (let's say) 20, you were X% more likely to have a miscarriage, if you actually managed to get pregnant at all. The jist of it is that egg quality starts to rapidly decline as cycle length goes on. So, the other part of my plan was that I would do blood work on day 20ish and if there was no sign of impending ovulation, I would take prometrium or yaz for ten days and then have a withdrawal bleed and start a new cycle.
I started on a low dose of metformin- 500mg once a day and gradually increased up to 850mg three times a day. I couldn't find any convincing information on how to appropriately calculate the dose needed and no one else I talked to seemed to have a firm answer either. So I decided more was better in this case. I'm not exaggerating when I say working up to this dose was an ass beating. I had some nausea and food aversion on the lower doses, but at some point I started throwing up and didn't stop for six weeks. Most of the time it was related to what I ate. Anything with carbs would make me puke. I lived off of cheese and protein shakes during this time. My husband was freaking out, but I kept reassuring him (and myself) that it would get better. And it did. A few weeks after I got to the highest dose, things started to settle down a bit. I still couldn't handle a lot of sugar and logically I knew that was probably a good thing. Illogically, I sat on the couch and cried because I thought I would never be able to eat a donut again.
The good news was, after about three months of metformin the side effects had mostly gone away and I had lost 25lbs. The bad news was, there was still no ovulation. I continued on with "the plan" though, determined to wait the full six months before moving onto the next thing. Another three months rolled by with the same results- no ovulation, no period. It was time to get serious.
To be continued...
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