Understanding Metformin: How It Works and Its Role and Limitations in PCOS Treatment

Polycystic Ovary Syndrome (PCOS) is a complex condition affecting millions of women worldwide. It is driven by insulin resistance, hormonal imbalances, and metabolic dysfunction, leading to symptoms like irregular cycles, weight gain, and fertility issues. One of the most commonly prescribed medications for PCOS is metformin, but while it can be helpful, it is not a standalone solution. Let’s break down how metformin works, its role in PCOS treatment, and why lifestyle changes are the key to long-term success.

How Metformin Works

Metformin is primarily used to treat type 2 diabetes, but it is also commonly prescribed to help manage insulin resistance in PCOS. It works by:

• Reducing glucose production – Metformin lowers the amount of glucose the liver produces, helping to keep blood sugar levels stable.
• Improving insulin sensitivity – It helps muscle cells become more responsive to insulin, allowing glucose to enter cells more efficiently.
• Decreasing glucose absorption – It slows the absorption of glucose from the intestines, reducing blood sugar spikes after meals.

How Metformin Helps with PCOS

Since insulin resistance plays a major role in PCOS, metformin can help manage some of the related symptoms, including:

• Weight management – Some women experience modest weight loss.
• More regular cycles – By improving insulin sensitivity, metformin can help restore ovulation.
• Lower androgens – High insulin levels drive excess androgen production, contributing to acne, excessive hair growth, and hair loss. Metformin can help lower insulin, which may reduce these symptoms.

The Limitations of Metformin

While metformin can help, it is not a magic bullet for PCOS. Here is why it often falls short:

• Minimal impact on weight loss – Some may lose a few pounds, but metformin alone is not enough to drive significant fat loss.
• Side effects – Many people struggle with nausea, diarrhea, and digestive discomfort, making it hard to stay on the medication.
• Does not address the root cause – Metformin treats insulin resistance but does nothing to stop the lifestyle factors that contribute to PCOS in the first place.

Why a Low Insulin Lifestyle Works Better

At Lilli Health, we focus on treating PCOS at the root by addressing insulin resistance through a Low Insulin Lifestyle. Unlike calorie restriction or traditional low-carb diets, this approach is designed to stabilize insulin levels, allowing metabolism and hormones to function properly.

Our research backs this up. In a randomized controlled trial presented at the American Society for Reproductive Medicine (ASRM), we compared a Low Insulin Lifestyle to the standard approach (low-calorie diet plus exercise, with metformin added when needed). The results were clear:

• Lower fasting insulin levels – Women following a Low Insulin Lifestyle saw a 35% reduction in fasting insulin within two months. In contrast, the control group’s insulin levels increased.
• Significant weight loss – The treatment group lost an average of 17 pounds in eight weeks, while the control group gained about a third of a pound.

These results highlight that metformin alone is not the answer—lowering insulin through diet and lifestyle changes leads to far greater improvements.

The Bottom Line

Metformin can be a useful tool for managing PCOS, but it is not the most effective solution on its own. The key to real, lasting improvement comes from lowering insulin levels naturally. A Low Insulin Lifestyle does more than just manage symptoms—it targets the underlying cause of PCOS, helping to restore hormone balance, support weight loss, and improve overall health.

Our full study will be published in a peer-reviewed journal soon, but in the meantime, you can start taking control of your PCOS today. The Lilli Health App provides the tools, education, and support to help you successfully adopt a Low Insulin Lifestyle and finally see the results you have been looking for.

Reference: 

Jackson B, et al. NUTRITIONAL EDUCATION (FACE-TO-FACE AND VIDEO INSTRUCTION) FOR POLYCYSTIC OVARY SYNDROME RESULTS IN GREATER REDUCTION IN BMI AND HEMOGLOBIN A1C THAN CALORIC RESTRICTION, EXERCISE AND METFORMIN. Fertility & Sterility 2022;118(4):E95 Read more