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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Trying To Conceive. Have PCOS. On Birth Control, Was On Mirena. Can I Take Metformin?

In july 2009 I went off bc and conceived in aprill 2010. I had a normal, healthy pregnancy. In march 2011 I had the mirena put in. I had that taken out in November 2011 because I had too many problems with it, and went back on birth control. In july 2012 I took the morning after pill(I was laid off). In sept 2012 after receiving my new dream job we decided to start ttc #2. After I took that morning after pill in July I never got a period(while on bc). After coming off bc I still had not had a period. I saw my ob in oct 2012 and he put me on provera. For the next 3 months I still had to take the provera to have a period. January 2013 he added progesterone. I had a period on my own in Feb but none after that. In may 2013 he dx me with PCOS(no ultrasound) and took me off provera and progesterone and put me on 1500mg of metformin, as of date I have not had a period. Is it possible for me to have developed PCOS since having a C-section with my daughter in jan 2011? Did the morning after pill some how mess my system up? Should I be pushing for more extensive testing? I know it took 9 months to conceiver her but I had a period each of those months, I just don't understand why all of sudden after taking that morning after pill they have completely stopped without medical intervention? Also with the metformin how do I know when day 1 is if I have yet to start a period from the last provera round?
Tue, 18 Jun 2013
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General & Family Physician,  's  Response
Hello and welcome to HCM.

Thank you for your query.

I can understand your concern and shall address your queries one by one.

Starting off with your first query, PCOS can be diagnosed clinically with the help of symptoms, but still requires a confirmation using an utrasound, which I advise at the earliest.

PCOS is a purely hormonal condition, thus affecting women in the reproductive age group, so the c-section would have nothing to do with this, but a hormonal imbalance could easily cause this.

The morning after pill has a known side effect to cause irregular bleeding and a change in the usual menstrual cycle, but to an extent equivalent to almost no period without medication, is usually not seen with the morning after pill. This could purely be a hormonal imbalance, and if the PCOS diagnosis is right, this could be directly attributed to the condition.

The more extensive testing you are talking about would include hormonal levels: estrogen, progesterone, testosterons, DHEAS, etc; along with an ultrasound to confirm the suspected diagnosis of PCOS.

Now coming to some extra information, metformin is advised in women diagnosed to have PCOS, for two purposes:
1. Normalize/regularize the menstrual cycle
2. Loss of weight (in woman who are slightly obese)
If you indeed have PCOS, and have noticed an increase in weight since the time when your cycles were normal, this could also be attributed to the weight gain. PCOS gets worse with weight gain, if you have put on weight, I would advise losing it.

It is difficult to calculate your day 1 right now, as your periods are very irregular. Let us wait till your periods are normalized, and then calculate the day 1.

I would also like to add, that metformin, birth control pills, hormonal supplements, etc; will all be used to normalize your period. Women with PCOS require a certain medication to help conceive (clomiphene), so this will be initiated only once your period is regular again, only once this is initiated, can you successfully conceive.

I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: http://doctor.healthcaremagic.com/doctors/dr-shoaib-khan/64581 . I would gladly help you.

Best wishes.
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Trying To Conceive. Have PCOS. On Birth Control, Was On Mirena. Can I Take Metformin?

Hello and welcome to HCM. Thank you for your query. I can understand your concern and shall address your queries one by one. Starting off with your first query, PCOS can be diagnosed clinically with the help of symptoms, but still requires a confirmation using an utrasound, which I advise at the earliest. PCOS is a purely hormonal condition, thus affecting women in the reproductive age group, so the c-section would have nothing to do with this, but a hormonal imbalance could easily cause this. The morning after pill has a known side effect to cause irregular bleeding and a change in the usual menstrual cycle, but to an extent equivalent to almost no period without medication, is usually not seen with the morning after pill. This could purely be a hormonal imbalance, and if the PCOS diagnosis is right, this could be directly attributed to the condition. The more extensive testing you are talking about would include hormonal levels: estrogen, progesterone, testosterons, DHEAS, etc; along with an ultrasound to confirm the suspected diagnosis of PCOS. Now coming to some extra information, metformin is advised in women diagnosed to have PCOS, for two purposes: 1. Normalize/regularize the menstrual cycle 2. Loss of weight (in woman who are slightly obese) If you indeed have PCOS, and have noticed an increase in weight since the time when your cycles were normal, this could also be attributed to the weight gain. PCOS gets worse with weight gain, if you have put on weight, I would advise losing it. It is difficult to calculate your day 1 right now, as your periods are very irregular. Let us wait till your periods are normalized, and then calculate the day 1. I would also like to add, that metformin, birth control pills, hormonal supplements, etc; will all be used to normalize your period. Women with PCOS require a certain medication to help conceive (clomiphene), so this will be initiated only once your period is regular again, only once this is initiated, can you successfully conceive. I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: http://doctor.healthcaremagic.com/doctors/dr-shoaib-khan/64581 . I would gladly help you. Best wishes.