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Cycle Regulation
by Samuel Thatcher, MD, Ph.D.
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 Q. I have PCOS, however I am not overweight or have a facial hair problem, so I went undiagnosed for years. The only tell tail sign was having no regular cycle (perhaps 1-3 periods a year). I conceived my daughter with metformin (clomid did nothing for me). Now I want to conceive again. I'm sure I will have to use Metformin again. My question is, IS there any way I can get regular fertile cycles back without the pill or using metformin in the short term? If not, will this mean that I will never have regular periods?
A. Unfortunately, PCOS is for life. The pattern of menstrual cycles is very individualized and is impossible to predict. We know that periods tend to become more regular after age 35. Periods often become more regular after pregnancy, but this didn't seem to work for you.
Generally, I believe it is better to have periods than not. One direct and proven benefit of regular menstruation is a reduction in uterine cancer. A alternative minimalistic therapy which usually does not impede fertility, and may promote it slightly, is the periodic use of oral progesterone. This may be preferred over Medroxyprogesterone acetate that you have probably used in the past.
In at least one way, you are lucky that metformin did so well for you. However, because it worked this may be an indication of insulin resistance and therefore, you could be at higher risk for type 2 diabetes. Trials are underway to see if long term metformin may protect against development of diabetes. We do not know the answer to this question. Perhaps, you should not consider metformin only as a fertility agent. A good sit down with your physician to discuss the options may be in order.
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