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

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting millions of women worldwide. Characterized by insulin resistance, hormonal imbalance, and metabolic syndrome, PCOS can lead to a variety of symptoms, including irregular menstrual cycles, weight gain, and fertility issues. One common medication prescribed for managing PCOS is metformin. But while metformin can be effective, it is not a standalone solution. This blog will explore how metformin works, its role in PCOS treatment, and why it often needs to be combined with lifestyle changes for optimal results.  

How Metformin Works 

Metformin is primarily prescribed to manage type 2 diabetes, but it is also frequently used to treat insulin resistance in women with PCOS. Here’s how it works: 

  • Reduces Glucose Production: Metformin decreases the amount of glucose produced by the liver, which helps lower blood sugar levels. 
  • Improves Insulin Sensitivity: It increases the sensitivity of muscle cells to insulin, allowing for better glucose uptake and utilization. 
  • Decreases Absorption of Glucose: Metformin reduces the absorption of glucose in the intestines, contributing to lower blood sugar levels. 

Metformin’s Role in PCOS Treatment 

For women with PCOS, metformin can help manage some of the metabolic issues associated with the condition. By improving insulin sensitivity, it can lead to: 

  • Weight Management: Some women may experience modest weight loss. 
  • Regulation of Menstrual Cycles: Improved insulin sensitivity can help regulate menstrual cycles. 
  • Reduction in Androgens: Lower insulin levels can decrease the production of androgens, reducing symptoms like excessive hair growth and acne. 

The Limitations of Metformin 

While metformin has its benefits, it is often not effective on its own for managing PCOS. Here’s why:  

  • Limited Impact on Weight Loss: Although metformin can lead to modest weight loss, it is usually not enough to significantly impact overall health and PCOS symptoms. 
  • Side Effects: Common side effects of metformin include gastrointestinal issues such as nausea, diarrhea, and abdominal discomfort, which can be difficult for some patients to tolerate. 
  • Does Not Address Root Cause: Metformin treats the symptoms of insulin resistance but does not address the underlying lifestyle factors that contribute to PCOS. 

The Low Insulin Lifestyle: A Superior Approach 

At Lilli Health, we advocate for a Low Insulin Lifestyle as the cornerstone of managing and potentially reversing insulin resistance and PCOS. Our approach is backed by robust clinical research, including a randomized controlled trial that was presented orally at the American Society for Reproductive Medicine (ASRM). 

Clinical Study Insights 

Our study compared the Low Insulin Lifestyle to standard of care (a low-calorie diet plus exercise) with the addition of metformin when clinically warranted. The interim analysis of 56 patients showed compelling results1: 

  • Fasting Insulin Reduction: Patients following the Low Insulin Lifestyle experienced a 35% reduction in fasting insulin levels within two months, despite the challenges posed by the COVID-19 pandemic. In contrast, the control group saw an increase in insulin levels. 
  • Weight Loss: The treatment group lost approximately 17 pounds over eight weeks, while the control group had a slight increase in weight (about 1/3 pound). 

These findings highlight the effectiveness of the Low Insulin Lifestyle in managing PCOS, far surpassing the results seen with metformin alone.  


While metformin can be a valuable tool in managing insulin resistance and PCOS, it is not a magic bullet. The most effective approach to treating PCOS involves addressing the root causes through lifestyle changes. At Lilli Health, our Low Insulin Lifestyle offers a comprehensive, evidence-based solution that not only improves insulin sensitivity and hormonal balance but also supports overall well-being. For those looking to manage their PCOS symptoms more effectively, a Low Insulin Lifestyle can provide significant relief and enhance quality of life, with or without metformin.  

Stay tuned for the publication of our full study in a peer-reviewed journal, where we will share more detailed insights and results. For personalized support and resources, consider exploring our Lilli Health App and consulting with a PCOS coach. Together, we can navigate the challenges of PCOS and work towards a healthier, more balanced life.