Thin pregnant cyster told to stop metformin @ 6 wks...any input?

Elly in PA · 11-09-2009, 09:21 AM

Hello Ladies, I'm wondering if anyone has any input about this issue. I am currently 5 wks pregnant and a thin, non-insulin resistant cyster. My doc has told me to stop taking the met after 6 wks but I am obviously scared. However, before anyone starts talking about all the research out there about the benefits (which I am fully aware of)...let me point out that I have YET to see any article about the benefits of metformin in lean pregnant PCOS patients...everything is about overweight, often insulin resistant women and the prevention of miscarriage. A lot of PCOSers miscarry on metformin as well, we just tend to focus on the ones that end in miscarriage after stopping the metformin...because we want something to blame (although I'm sure it may be to blame in many overweight cysters). So, in short, has anyone been given this advice? Has any thin PCOSers stopped taking metfomrin while pregnant? Did you step down the dose first? Any input would be great!

JLWallace · 11-09-2009, 01:46 PM

My OB had me stop at week 12, which worked perfect because I ran out at that time. I weaned myself, too... I was on 1,000mg/day then went down to 500mg/day for that last 2 weeks and it helped a lot. I am also a thin cyster... my IR isn't that bad either, but my OB felt pretty confident that it would help things along. I'll be 16 weeks tomorrow so maybe the Met was a good idea after all
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Natelover · 11-09-2009, 01:49 PM

My doctor told me to drop it cold turkey at 5 wks. I don't think it is approved for pregnant women in Canada so I think he is covering his butt. I haven't had any trouble since then. I hated being on it because it made me so sick and was thrilled to drop it.

NikiAngel · 11-09-2009, 02:01 PM

Elly - thanks for getting this started, I too am very curious. I haven't got there yet, but my RE said that he would keep me on as a precautionary measure through week 12, and then it was ultimately up to the OBGYN but his recommendation is to stop. I am very fit, thin and non-IR. IE I am 5'4" 117 pounds and in perfect health other than of course PCOS. I have had a miscarriage at 12 weeks so of course I have my doubts, but like you said there seems to be no indication leading to believe that it could prevent a M/C in a non-IR patient. My RE said that the drug's usage for IF and pregnacy is categorized as safe, but he doesn't believe it's been used long enough for there to be conclusive data indicating that no possible defects are caused by it. He said if I were overweight, IR or at risk for gestational diabetes it would be a different story.

I am going to follow this thread since I am really curious about other experiences.

Cookie216 · 11-09-2009, 02:13 PM

With my pregnancy #1, I was told to stay on it (Met ER 1,000mg) until the end of week 13th. Studies have shown it does significantly reduce the risk of miscarriage and I don't think being "lean" or "obese" has anything to do with it. It's whether or not you have insulin resistance...I do and I'm lean. If Metformin helped regulate your period and you got pregnant on it, then it's obviously helping you and you have some form of IR. I'd get a second opinion before stopping it.

I'm on pregnancy #2, I'm still lean and will be taking it through Week 13.

NikiAngel · 11-09-2009, 02:17 PM

Cookie - is that the key you think the IR? I am not IR, and Met didn't help me get my period- I went ahead with AR and just completed IVF and will be doing an FET. RE said since i was on the met and used to it, it could help more than it could hurt - but sounds like my 12 week advice is similar to your wk 13 advice so I feel pretty confident!

Cookie216 · 11-09-2009, 03:04 PM

Yes, IR is key to Met working for PCOS. Met increases the sensitivity of muscle cells to insulin. This will reduce Insulin Resistance (a key contributor to PCOS in some women) and therefore, normalizes cycles and restore ovulation/fertility.

How long were you on Met? It took me 80 days to get my first period from it and then it was like clockwork (every 28-30 days) after that. It can take quite awhile for it to work.

NikiAngel · 11-09-2009, 03:09 PM

I was on Metformin for 5 months with no period before I started AR. So I guess 150 days or so.

Sherrylen9 · 11-09-2009, 03:25 PM

I wasn't IR years ago, but I did have PCOS and didn't know it. I miscarried 3 times before getting a diagnosis. I am no longer thin, but this time I stayed on Met until week 14. Although I think the placenta takes over at week 12. So from my personal experience, I would say stay on it until week 12. The Metformin assist in becoming pregnant, and reduces the risk of miscarrying until the placenta takes over. Good Luck and H&H 9 months!

*Jenny* · 11-09-2009, 03:39 PM

I'm wondering why you were on met to begin with if you aren't overweight and don't have insulin problems. I am also a 'thin' cyster with no insulin problems and my GP, OB and fertility specialist all said that met wasn't necessary. I've never been on it at all and am perfectly happily 27 weeks pregnant
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Nikki022103 · 11-09-2009, 03:56 PM

I was just in the thin cyster site. I am also a thin cyster, and I have been on met for about 3 weeks. Some of the other thin cysters sited a few articles which stated in some PCOS women their sensitivity to insulin was different in their ovaries than in their muscle. They would never test IR via a glucose test (I did not), but the ovaries may be IR anyways resulting in the abnormal hormones. I think the reason many women stay on met through 12 weeks is because until then it is up to the ovaries to produce the needed hormones (in early pg this is progesterone), and after 12 weeks the placenta takes over the progesterone production. Theoretically if your ovaries are IR (even if your blood test does not show it), then suddenly going off met while the ovaries are responsible to produce enough progesterone to sustain the pg it could result in mc. This is what I've gathered from the info I've read. If anyone feels the need to correct me please do because some of the reading can be a little confusing, but I plan to stay on met at least through the first tri if I ever get my BFP.

Elly in PA · 11-09-2009, 06:37 PM

Yes, most of the studies out there agree that even if you are thin and not IR by lab blood tests, metformin can still have positive effects. As you can see in my signature I rarely ovulate and don't get my period...as soon as I started taking the metformin I had ovarian pain and my nipples became very sensitive...two weeks later I ovulated...and thus the BFP! I am convinced the metformin woke up my ovaries as I've never had those kind of symptoms before. Anyhoo, thanks for the input ladies... I hope some other people chime in as well. I am thinking that at the 6 week point I will halve my dosage down to 750 mg and continue taking that until the end of the 12 weeks (possibly). Of course I will try to get a hold of my doctor again to discuss this with him but you guys' input is very valuable!

Elly in PA · 11-09-2009, 06:39 PM

Also, my OB/gyn has 1000s of patients and he wanted to put me on metformin as the first line agent and to see if it would make me ovulate within 3 months. If it did not (it did) he would discuss all the clomid stuff as an alternative option. Those carry far more risks with them than just metformin does so he thought that if I am patient enough to just try met, he would rather that.

KaitlynH · 11-09-2009, 07:20 PM

I'm a thin cyster who's non-IR. I asked my RE nurse about this earlier today, and she said that they would keep me on it thru the first trimester. It's kinda a pain in the butt to still be on it, but I figure if it lowers my mc rate by even .001 of a percent its worth it!

Goose00 · 11-09-2009, 08:45 PM

Elly,

I am a thin cyster who is 28 weeks pregnant today (hello third trimester!). My BMI was 21 (pre-preggo of course), no signs of insulin resistance, excellent blood sugar, healthy body fat. . etc. But I didn't O' at all until I started Met. It took me a few months (longer than you it looks like) but I I did conceive on Met alone.

Anyway, getting to your question, my RE insisted that I stop Met cold turkey the day I got my BFP, which was at 4 weeks. No tapering. . .just stop all out right then and there. He is a well respected RE who specializes in PCOS and had some strong opinions on it. He said that some smaller studies show a lower miscarriage risk on Met, but larger, better run studies do not prove a reduce risk. He also said that the association between PCOS and miscarriage is often overstated. Obesity, not PCOS, is known to be a major cause of miscarriage, and since PCOS and obesity are often related it tends to cause confusion. He insists that the risk is not reduced for any sized woman, however.

Anyway, I was very concerned, but I decided not to outsmart my Dr., so I stopped it like he said. And my pregnancy has progressed normally without any problems. I also had my gestational diabetes testing two weeks ago and it came back fine. So I hope this provides you with some reassurance. Best of luck to you and congrats on the BFP!!