What is Cushing’s Syndrome?
Winnie Mwangi • May 20, 2021 • 5 min read
Cushing’s syndrome is patients with Cushing’s syndrome have too much cortisol. Cortisol is produced by the adrenal glands and helps the body respond to stress. Cushing’s syndrome can be exogenous or endogenous. Accurate management of the condition depends on first identifying the underlying cause of the disorder.
Exogenous Cushing’s syndrome affects people who take glucocorticoids (steroids). Those at most risk are patients with chronic health conditions, requiring long-term treatment; for example, asthma, rheumatoid arthritis and lupus.
Endogenous Cushing’s syndrome is caused by the body producing too much cortisol.
Adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome comprises 80-85% of endogenous cases, with the majority of these attributable to tumors of the pituitary gland. ACTH tells the adrenal glands, located next to the kidneys, to produce cortisol. Too much ACTH results in too much cortisol. This form of ACTH-dependent Cushing’s syndrome is more accurately known as Cushing’s disease.
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I’m Worried my Progesterone Levels are too High
Are high [progesterone](https://nabtahealth.com/glossary/progesterone/) levels causing concern? Understanding the impact of elevated [progesterone](https://nabtahealth.com/glossary/progesterone/) is crucial for maintaining hormonal balance and overall health. [Progesterone](https://nabtahealth.com/glossary/progesterone/) plays a vital part in the menstrual cycle and pregnancy, but when levels rise unreasonably, it can [lead](https://nabtahealth.com/glossary/lead/) to different indications and well-being challenges. This article dives into the signs, causes, and suggestions of tall [progesterone](https://nabtahealth.com/glossary/progesterone/) levels, advertising clear experiences and viable counsel to address this common hormonal issue. Whether experiencing symptoms or seeking preventative measures, powering yourself with knowledge can guide you toward optimal hormonal wellness. You’re not alone in this journey; we’re here to support you. * High [progesterone](https://nabtahealth.com/glossary/progesterone/) symptoms include fatigue, bloating, breast tenderness and [vaginal dryness](https://nabtahealth.com/articles/5-reasons-why-you-may-be-experiencing-vaginal-dryness). * [Progesterone](https://nabtahealth.com/glossary/progesterone/) naturally increases when you become pregnant. * Maintaining [progesterone](https://nabtahealth.com/glossary/progesterone/) at a ‘normal’ level has health benefits, for example it can help boost your mood. * Low [progesterone](https://nabtahealth.com/glossary/progesterone/) levels is one of the characteristics of [anovulation](https://nabtahealth.com/glossary/anovulation/) (lack of [ovulation](https://nabtahealth.com/glossary/ovulation/)), which is a symptom of [PCOS](https://nabtahealth.com/glossary/pcos/). * If your [progesterone](https://nabtahealth.com/glossary/progesterone/) levels are too high and you are not pregnant, some causes can include ovarian cysts, congenital [adrenal hyperplasia](https://nabtahealth.com/glossary/adrenal-hyperplasia/) and ovarian cancer. #### I have high [progesterone](https://nabtahealth.com/glossary/progesterone/) symptoms. Am I pregnant? Measuring your [progesterone](https://nabtahealth.com/glossary/progesterone/) levels is a good way of confirming whether or not [ovulation](https://nabtahealth.com/glossary/ovulation/) has taken place. However, high or low [progesterone](https://nabtahealth.com/glossary/progesterone/) can be associated with other conditions. #### My [progesterone](https://nabtahealth.com/glossary/progesterone/) is low… One of the [main symptoms of](../what-is-pcos) [PCOS](https://nabtahealth.com/glossary/pcos/) is [anovulation](https://nabtahealth.com/glossary/anovulation/) (failure to ovulate), characterized by [low](../what-happens-if-my-progesterone-levels-are-too-low) [progesterone](https://nabtahealth.com/glossary/progesterone/). To diagnose [PCOS](https://nabtahealth.com/glossary/pcos/), most guidelines state that two out of the three main symptoms ([anovulation](https://nabtahealth.com/glossary/anovulation/), [hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/), and polycystic [ovaries](https://nabtahealth.com/glossary/ovaries/)) should be present. It is possible to have [](https://nabtahealth.com/i-have-regular-periods-could-i-still-have-pcos/)[PCOS](https://nabtahealth.com/glossary/pcos/) and also have periods that are regular. A lack of [progesterone](https://nabtahealth.com/glossary/progesterone/), in addition to serving as a marker of [anovulation](https://nabtahealth.com/glossary/anovulation/), also contributes to higher circulating levels of [testosterone](https://nabtahealth.com/glossary/testosterone/), contributing to another of the major symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/), [hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/). [Boosting low](https://nabtahealth.com/alternatives-to-progesterone-supplements-for-managing-pcos/) [progesterone](https://nabtahealth.com/glossary/progesterone/) levels has health benefits (preventing over-exposure of the [uterus](https://nabtahealth.com/glossary/uterus/) to [oestrogen](https://nabtahealth.com/glossary/oestrogen/)) and will serve as a natural mood enhancer. If you are concerned that your [progesterone](https://nabtahealth.com/glossary/progesterone/) levels are too high, find out quickly, discreetly, and conveniently by taking an [at-home women’s health fertility test](https://nabtahealth.com/product/womens-fertility-test/). The results will allow you to make informed decisions about your next steps. #### But, what about if [progesterone](https://nabtahealth.com/glossary/progesterone/) levels are higher than normal? First, it is worth considering what is ‘normal? [Progesterone](https://nabtahealth.com/glossary/progesterone/) levels in the serum naturally fluctuate, not just throughout the menstrual cycle, when they can feasibly go from 0 to 20ng/ml, but also on an hour-by-hour basis. This makes defining ‘normal’ challenging. [Progesterone](https://nabtahealth.com/glossary/progesterone/) is not present at all during the follicular phase of the cycle and will only start to rise after [ovulation](https://nabtahealth.com/glossary/ovulation/), reaching a peak 7-5 days before menstruation starts. This peak is often around 8ng/ml, but can be as high as 20ng/ml. Without fertilization, [progesterone](https://nabtahealth.com/glossary/progesterone/) levels fall swiftly back to zero for the start of the next menstrual cycle. If fertilization does occur, Chart will remain high as the hormone helps to prepare the body for pregnancy. Symptoms of high [progesterone](https://nabtahealth.com/glossary/progesterone/) include fatigue, bloating, moodiness, breast tenderness, and vaginal dryness, these can all be very [](../subtle-signs-of-pregnancy)[early signs of pregnancy](../subtle-signs-of-pregnancy). It is not abnormal for [progesterone](https://nabtahealth.com/glossary/progesterone/) levels to reach 85-90ng/ml during the first and second trimester, dropping to approximately 45ng/ml in the third trimester as the body prepares for birth. Multiple births (twins or triplets) usually give rise to higher than average levels. So, if your [progesterone](https://nabtahealth.com/glossary/progesterone/) levels seem high, the first thing to consider is whether or not you might be pregnant. #### I’m not pregnant; what else causes high [progesterone](https://nabtahealth.com/glossary/progesterone/) levels? If pregnancy is not the reason for higher than normal [progesterone](https://nabtahealth.com/glossary/progesterone/) levels, there are a few other conditions that might [lead](https://nabtahealth.com/glossary/lead/) to high levels of the hormone: * [Ovarian cysts](../are-ovarian-cysts-the-same-thing-as-pcos). Some ovarian cysts occur alongside an excess of [progesterone](https://nabtahealth.com/glossary/progesterone/), however, which causes which is unclear. Ovarian cysts are usually [benign](https://nabtahealth.com/glossary/benign/), often form as part of normal menstruation and, unless they rupture, will generally cause few side effects. (If you have [ovarian cysts you do not necessarily have](https://nabtahealth.com/are-ovarian-cysts-the-same-thing-as-pcos/) [PCOS](https://nabtahealth.com/glossary/pcos/).) * Congenital [adrenal hyperplasia](https://nabtahealth.com/glossary/adrenal-hyperplasia/). A group of rare inherited conditions that affect the production of hormones, including [androgens](https://nabtahealth.com/glossary/androgen/), by the adrenal glands. * [Ovarian cancer](https://nabtahealth.com/ovarian-cancer-symptoms/) and adrenal cancer. These are both rare and will usually be accompanied by other symptoms such as pain and bleeding. To conclude, if you have high levels of [progesterone](https://nabtahealth.com/glossary/progesterone/), the first thing to do is re-test your chart, taking into account the tendency for fluctuations in readings. Also, bear in mind that having healthy levels of [progesterone](https://nabtahealth.com/glossary/progesterone/) is generally a good thing; it makes periods lighter, reduces anxiety, is anti-inflammatory, and improves the appearance of the skin and hair. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#334a525f5f52735d525147525b56525f475b1d505c5e) if you have any questions about this article or any aspect of women’s health. We’re here for you. #### **Sources:** Briden, L. “Roadmap to [Progesterone](https://nabtahealth.com/glossary/progesterone/).” _Lara Briden – The Period Revolutionary_, 19 Jan. 2014, [www.larabriden.com/road-map-to-](http://www.larabriden.com/road-map-to-progesterone/)[progesterone](https://nabtahealth.com/glossary/progesterone/)/. Holm, G. “Serum [Progesterone](https://nabtahealth.com/glossary/progesterone/) Test: Purpose, Results, and Risks.” _Healthline_, [www.healthline.com/health/serum-](http://www.healthline.com/health/serum-progesterone)[progesterone](https://nabtahealth.com/glossary/progesterone/). Medically reviewed by University of Illinois-Chicago, College of Medicine on August 22, 2016. “[Progesterone](https://nabtahealth.com/glossary/progesterone/).” _Lab Tests Online_, AACC, [labtestsonline.org/tests/](http://labtestsonline.org/tests/progesterone)[progesterone](https://nabtahealth.com/glossary/progesterone/). This article was last modified on December 28, 2018.
Can PCOS Cause Urinary and Bowel Issues ? [2014]
Polycystic ovary syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)) is a common hormonal disorder that affects women of reproductive age. It is caused by a hormonal imbalance in the body and can [lead](https://nabtahealth.com/glossary/lead/) to a number of symptoms, including irregular menstrual periods, excess hair growth, acne, and weight gain. While urinary and bowel issues are not typically considered common symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/), they can occur in some individuals with the condition. The most common urinary symptom associated with [PCOS](https://nabtahealth.com/glossary/pcos/) is urinary tract infections (UTIs), which can cause symptoms such as frequent or urgent urination, [pain or burning during urination](https://nabtahealth.com/articles/can-pcos-cause-urinary-and-bowel-issues/), and cloudy or bloody urine. These symptoms can be treated with antibiotics. * [PCOS](https://nabtahealth.com/glossary/pcos/) cause urinary and bowel issues even when women have non-classic [PCOS](https://nabtahealth.com/glossary/pcos/). * This is because the cysts may press against the bladder and rectum (bowel). * Cysts can be removed under general anaesthetic. * [PCOS](https://nabtahealth.com/glossary/pcos/) symptoms can be relieved through changing your lifestyle. #### Classic and Non-Classic [PCOS](https://nabtahealth.com/glossary/pcos/) Despite its name, polycystic ovary syndrome [](https://nabtahealth.com/do-polycystic-ovaries-equal-pcos/)[does not require the presence of polycystic](https://nabtahealth.com/do-polycystic-ovaries-equal-pcos/) [](https://nabtahealth.com/do-polycystic-ovaries-equal-pcos/)[ovaries](https://nabtahealth.com/glossary/ovaries/). In fact, when present together, excess of male hormones ([hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/)) and lack of [ovulation](https://nabtahealth.com/glossary/ovulation/) ([anovulation](https://nabtahealth.com/glossary/anovulation/)) comprise the [classic form of](https://nabtahealth.com/what-is-pcos/) [PCOS](https://nabtahealth.com/glossary/pcos/), which is more common and generally associated with more severe side effects than the non-classic form. Women who have non-classic [PCOS](https://nabtahealth.com/glossary/pcos/) can have [polycystic](https://en.wikipedia.org/wiki/Polycystic_ovary_syndrome) [ovaries](https://nabtahealth.com/glossary/ovaries/) with regular menstrual cycles and [](https://nabtahealth.com/is-hyperandrogenism-a-symptom-of-pcos/)[hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/) (non-classic ovulatory [PCOS](https://nabtahealth.com/glossary/pcos/)). Or they can have normal [androgens](https://nabtahealth.com/glossary/androgen/) but experience chronic [anovulation](https://nabtahealth.com/glossary/anovulation/) (non-classic mild/normoandrogenic [PCOS](https://nabtahealth.com/glossary/pcos/)). #### [PCOS](https://nabtahealth.com/glossary/pcos/) Can Cause Urinary and Bowel Issues Although non-classic [PCOS](https://nabtahealth.com/glossary/pcos/) is typically milder, those women who have extensive ovarian cysts may experience pain in the pelvic region where the cysts press against the bladder and rectum. Associated symptoms include nausea, urinary conditions, and [constipation](https://nabtahealth.com/glossary/constipation/). Depending on the severity of the symptoms, treatment options range from over-the-counter pain relief medication to cyst removal under general anaesthetic. Ultrasound investigation will be used to establish how invasive the cysts are. In addition to the pain and pressure caused by the presence of cysts in the abdominal region, many women with [PCOS](https://nabtahealth.com/glossary/pcos/) experience symptoms that are usually associated with diabetes. This is probably because a large proportion of women with the condition are insulin resistant. Symptoms such as sugar cravings, frequent urination, blurred vision, delayed healing, and a tingling sensation have all been reported. To date, the most effective way of relieving the symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/) is through the implementation of [lifestyle changes](https://nabtahealth.com/is-it-possible-to-reverse-pcos/), such as weight loss. What are the common urinary and bowel symptoms associated with [PCOS](https://nabtahealth.com/glossary/pcos/)? -------------------------------------------------------------------------------------------------------------- * Polycystic ovary syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)) is a common hormonal disorder that affects women of reproductive age. * It is caused by a hormonal imbalance in the body and can [lead](https://nabtahealth.com/glossary/lead/) to a number of symptoms, including irregular menstrual periods, excess hair growth, acne, and weight gain. * While urinary and bowel issues are not typically considered common symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/), they can occur in some individuals with the condition. * The most common urinary symptom associated with [PCOS](https://nabtahealth.com/glossary/pcos/) is urinary tract infections (UTIs), which can cause symptoms such as frequent or urgent urination, pain or burning during urination, and cloudy or bloody urine. * Another urinary issue that can occur with [PCOS](https://nabtahealth.com/glossary/pcos/) is incontinence, or the inability to control the release of urine from the bladder. * [Constipation](https://nabtahealth.com/glossary/constipation/) is a common symptom of [PCOS](https://nabtahealth.com/glossary/pcos/). This can be caused by hormonal imbalances and changes in the levels of insulin and other hormones in the body. * It’s important to talk to a doctor if you have [PCOS](https://nabtahealth.com/glossary/pcos/) and are experiencing any symptoms related to your urinary or bowel health. They can help diagnose and treat any underlying issues and provide you with the care and support you need to manage your condition. To read more about factors that are associated with [PCOS](https://nabtahealth.com/glossary/pcos/) click [here](https://nabtahealth.com/treating-the-associated-symptoms-of-pcos/) and consider Nabta’s [](https://nabtahealth.com/product/pcos-test/)[PCOS](https://nabtahealth.com/glossary/pcos/) Test to understand more. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#81f8e0edede0c1efe0e3f5e0e9e4e0edf5e9afe2eeec) if you have any questions about this article or any aspect of women’s health. We’re here for you. FAQ’s On [PCOS](https://nabtahealth.com/glossary/pcos/) Cause Urinary and Bowel Issues? --------------------------------------------------------------------------------------- ### Can [PCOS](https://nabtahealth.com/glossary/pcos/) Cause Blood In Urine Yes, Polycystic Ovary Syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)) can indirectly cause blood in urine due to associated conditions like urinary tract infections (UTIs) or kidney issues. It’s important to consult a healthcare provider for an accurate diagnosis and appropriate treatment. ### [PCOS](https://nabtahealth.com/glossary/pcos/) Urine Color [PCOS](https://nabtahealth.com/glossary/pcos/) does not usually change urine color directly. However, related conditions such as UTIs or dehydration can cause urine to appear darker, cloudy, or bloody. Consult a healthcare provider if you notice unusual changes in urine color. Does [PCOS](https://nabtahealth.com/glossary/pcos/) Cause You To Pee a Lot -------------------------------------------------------------------------- Yes, [PCOS](https://nabtahealth.com/glossary/pcos/) can cause you to pee a lot due to related conditions like [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) or diabetes, which can increase thirst and urination. It’s essential to consult a healthcare provider for proper diagnosis and management. ### Can [PCOS](https://nabtahealth.com/glossary/pcos/) Cause UTI Yes, [PCOS](https://nabtahealth.com/glossary/pcos/) can increase the risk of urinary tract infections (UTIs) due to hormonal imbalances and [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/). It’s important to consult a healthcare provider for proper diagnosis and treatment. ### [PCOS](https://nabtahealth.com/glossary/pcos/) Peeing a Lot Yes, [PCOS](https://nabtahealth.com/glossary/pcos/) can cause frequent urination due to associated conditions like [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) or diabetes, which can [lead](https://nabtahealth.com/glossary/lead/) to increased thirst and urination. Consult a healthcare provider for proper diagnosis and management. #### **Sources:** El Hayak, S, et al. “Poly Cystic Ovarian Syndrome: An Updated Overview.” _Frontiers in Physiology_, vol. 7, 5 Apr. 2016, p. 124., doi:10.3389/fphys.2016.00124. Norman, R J, et al. “The Role of Lifestyle Modification in Polycystic Ovary Syndrome.” _Trends in Endocrinology and [Metabolism](https://nabtahealth.com/glossary/metabolism/)_, vol. 13, no. 6, Aug. 2002, pp. 251–257. Patel, S. “Polycystic Ovary Syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)), an Inflammatory, Systemic, Lifestyle Endocrinopathy.” _The Journal of Steroid Biochemistry and Molecular Biology_, vol. 182, Sept. 2018, pp. 27–36., doi:10.1016/j.jsbmb.2018.04.008.
I Have PCOS; Should I Take Metformin?
* [PCOS](https://nabtahealth.com/glossary/pcos/) is sometimes treated with metformin, a drug for [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/). * 60-70% of women with [PCOS](https://nabtahealth.com/glossary/pcos/) are insulin resistant which is why metformin may be prescribed. * Clinical studies exploring metformin and [PCOS](https://nabtahealth.com/glossary/pcos/) symptoms have been small and inconsistent, but there is some evidence metformin increases [ovulation](https://nabtahealth.com/glossary/ovulation/) rate in women with [PCOS](https://nabtahealth.com/glossary/pcos/) when compared to treatment with a placebo. * Other studies have found that there is no consistent evidence that metformin improves the signs of hyperandrogegism (such as hairiness from excess male hormones). * However, metformin should not be completely discounted as an option for the management of [PCOS](https://nabtahealth.com/glossary/pcos/) [Metformin](https://nabtahealth.com/what-is-metformin/) is the first line treatment approach for type 2 diabetes mellitus (T2DM). It works by improving the way in which the body responds to insulin, preventing blood sugar levels from getting too high. Metformin is not licensed for the treatment of [](https://nabtahealth.com/what-is-pcos/)[PCOS](https://nabtahealth.com/glossary/pcos/), but as many women with the condition are [insulin resistant](https://nabtahealth.com/treating-the-associated-symptoms-of-pcos/), it is often prescribed ‘off label’ to help manage the symptoms. This article aims to address some questions regarding the use of metformin in the management of [PCOS](https://nabtahealth.com/glossary/pcos/). Is there justification in its use? Can it help to improve the symptoms of the condition, or are there alternative options that will be more effective? Will there ever be a time when metformin is prescribed as standard for all women with [PCOS](https://nabtahealth.com/glossary/pcos/) and to treat [PCOS](https://nabtahealth.com/glossary/pcos/) side effects? #### **Why metformin and [PCOS](https://nabtahealth.com/glossary/pcos/)?** Metformin is safe and cost effective, hence it’s widespread use in the management of T2DM. [Insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) is not one of the three diagnostic criteria used in defining [PCOS](https://nabtahealth.com/glossary/pcos/), however it is recognised as a common feature. In fact, 60-70% of women with [PCOS](https://nabtahealth.com/glossary/pcos/) will be insulin resistant and it is thought that the higher than normal levels of insulin contribute to many of the phenotypic traits of the condition. Thus, it makes sense that treating the [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) might help to alleviate other [PCOS](https://nabtahealth.com/glossary/pcos/) side effects, for example regulating the menstrual cycle and improving signs of unwanted hair growth and acne. #### **What does the science say about [PCOS](https://nabtahealth.com/glossary/pcos/) and metformin?** Unfortunately metformin has not turned out to be the wonder drug that some anticipated. The clinical studies to date have largely been small in sample size and results have been inconsistent. In 2017, the American Society for Reproductive Medicine published guidelines on the use of metformin for the treatment of [infertility](https://nabtahealth.com/glossary/infertility/) in women with [PCOS](https://nabtahealth.com/glossary/pcos/). They based these guidelines on the results of a comprehensive literature review. The main conclusions reached were: * There is some evidence that metformin increases [ovulation](https://nabtahealth.com/glossary/ovulation/) rate in women with [PCOS](https://nabtahealth.com/glossary/pcos/) when compared to treatment with a placebo. **However:** * Clomiphene citrate is more effective at inducing [ovulation](https://nabtahealth.com/glossary/ovulation/) than metformin. * Metformin plus clomiphene citrate is more effective than metformin alone. * There is insufficient data on pregnancy and live birth rates following metformin treatment. Thus, the longer term overall reproductive benefit cannot currently be established. **Furthermore:** * There is insufficient evidence to recommend metformin as an option to [reduce the risk of](https://nabtahealth.com/pcos-and-pregnancy/) [miscarriage](https://nabtahealth.com/glossary/miscarriage/) in women with [PCOS](https://nabtahealth.com/glossary/pcos/). * Preliminary work suggesting that preventative treatment with metformin reduces the risk of [](https://nabtahealth.com/gestational-diabetes-8-things-you-should-know/)[gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) has not been replicated in newer studies. The final conclusion reached by the Society was that they would not recommend metformin as the first line treatment approach for [ovulation](https://nabtahealth.com/glossary/ovulation/) induction. Medications such as clomiphene citrate, known to be an [ovulation](https://nabtahealth.com/glossary/ovulation/) inducer, are generally more effective than metformin for women who are experiencing [PCOS](https://nabtahealth.com/glossary/pcos/)\-related fertility issues. In addition to these findings, other studies have found that there is no consistent evidence that metformin improves the signs of [](https://nabtahealth.com/masculine-hormones-in-women/)[hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/). #### **The outlook for metformin as a [PCOS](https://nabtahealth.com/glossary/pcos/) treatment** Metformin should not be completely discounted as an option for the management of [PCOS](https://nabtahealth.com/glossary/pcos/). Whilst less effective than other options, metformin has been shown to restore [ovulation](https://nabtahealth.com/glossary/ovulation/) in some women with [PCOS](https://nabtahealth.com/glossary/pcos/). For women with [PCOS](https://nabtahealth.com/glossary/pcos/) clomiphene citrate is commonly used to induce [ovulation](https://nabtahealth.com/glossary/ovulation/), however, not all women respond to treatment with this drug. For the women that do not respond, it is possible that combination therapy with metformin may be more successful at inducing [ovulation](https://nabtahealth.com/glossary/ovulation/). However, the work on this to date is limited. There is a need for longer term studies on metformin, as most studies have only explored short course treatment approaches. [PCOS](https://nabtahealth.com/glossary/pcos/) varies considerably from woman to woman. The presenting symptoms differ in both type and severity, which is why [diagnosing it can be so challenging](https://nabtahealth.com/problems-with-traditional-diagnosis-of-pcos/). Women with [PCOS](https://nabtahealth.com/glossary/pcos/) are prone to other conditions such as obesity and [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/); they are also at greater risk of developing T2DM and [endometrial cancer](https://nabtahealth.com/a-guide-to-endometrial-cancer/). Whether metformin can be given prophylactically to reduce these risks remains unclear and once again highlights the need for longer-term studies with extensive follow-up periods. #### Will metformin be prescribed as standard to all women that receive a diagnosis of [PCOS](https://nabtahealth.com/glossary/pcos/)? Unlikely. A more valuable course of action would be for doctors to better understand the various [PCOS](https://nabtahealth.com/glossary/pcos/) phenotypes and thus, take a more individualised approach to treatment, deciding which of their patients could genuinely benefit from treatment with the drug. As a final note, the value of [lifestyle modifications](https://nabtahealth.com/is-it-possible-to-reverse-pcos/) should not be understated. Adopting lifestyle changes and losing weight has proven to be, by far, the best approach for managing the symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/). It is also the most effective way for women with [PCOS](https://nabtahealth.com/glossary/pcos/) to reduce their risk of developing T2DM. Medication should remain a contingency strategy for use in those who do respond adequately to lifestyle alterations. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#a0d9c1ccccc1e0cec1c2d4c1c8c5c1ccd4c88ec3cfcd) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Lashen, Hany. “Review: Role of Metformin in the Management of Polycystic Ovary Syndrome.” Therapeutic Advances in Endocrinology and [Metabolism](https://nabtahealth.com/glossary/metabolism/), vol. 1, no. 3, June 2010, pp. 117–128., doi:10.1177/2042018810380215. * Practice Committee of the American Society for Reproductive Medicine (Penzias, Alan, et al.) “Role of Metformin for [Ovulation](https://nabtahealth.com/glossary/ovulation/) Induction in Infertile Patients with Polycystic Ovary Syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)): a Guideline.” Fertility and Sterility, vol. 108, no. 3, Sept. 2017, pp. 426–441., doi:10.1016/j.fertnstert.2017.06.026. * “Summary of Possible Benefits and Harms: Information for the Public: Polycystic Ovary Syndrome: Metformin in Women Not Planning Pregnancy: Advice.” NICE, Feb. 2013, [www.nice.org.uk/advice/esuom6/ifp/chapter/Summary-of-possible-benefits-and-harms](http://www.nice.org.uk/advice/esuom6/ifp/chapter/Summary-of-possible-benefits-and-harms). * “Treatment. Polycystic Ovary Syndrome .” NHS Choices, NHS, [www.nhs.uk/conditions/polycystic-ovary-syndrome-](http://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/)[pcos](https://nabtahealth.com/glossary/pcos/)/treatment/. * Yarandi, Razieh Bidhendi, et al. “Metformin Therapy before Conception versus throughout the Pregnancy and Risk of [Gestational Diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) Mellitus in Women with Polycystic Ovary Syndrome: a Systemic Review, Meta-Analysis and Meta-Regression.” Diabetology & Metabolic Syndrome, vol. 11, no. 1, 23 July 2019, doi:10.1186/s13098-019-0453-7. * Zhou, Joseph, et al. “Metformin: An Old Drug with New Applications.” International Journal of Molecular Sciences, vol. 19, no. 10, 21 Sept. 2018, p. 2863., doi:10.3390/ijms19102863.