The Hemp Connection + women's health

A note to physicians prescribing metformin to women with PCOS

Dear Doctors,

I've been studying PCOS for about 10 years now. In that time, I've seen the standard dose of metformin double. As the dosage has slowly crept up, I have, more often, heard women complain that the side effects of metformin are so horrible that they stop taking it completely.

There are several ways you can look at this problem.

1. You can continue to prescribe the bigger dose of metformin because the lower dose isn't working, you have a limited amount of time to talk to your patient, and you want to feel like you did something. And you can continue to fail at adequately managing the process.

2. You can blame the problem on the patient. You can tell her she simply needs to hang in there for several months and be nauseous and miserable for 3 months while she waits for, with great hope, the side effects to subside.

I can't tell you what to do. But I can tell you, women who are not following their medication prescriptions are telling you something very important. That is, that increasing the dose of a medication they are not taking, is not the answer to the problem.

Have you considered what happens when your client does not eat in order to try to tolerate her medication without throwing up? She likely binge eats later in the day. There goes self-esteem, calorie control, and blood glucose management.

Have you considered what happens when she gives up on trying to follow your recommendations because she's too sick anymore to try? She stops coming in for checkups, providing ample opportunity for that inflammatory process to affect her brain, her nervous system, her ovaries, and her arteries, to name a few. She potentially shortens the duration, not to mention the quality of, her life.

Have you considered that when a woman takes a half a day off to sit in your office, waiting to see you, and patiently sits there even though you're running an hour behind, that the last thing she needs to hear from you is that she just needs to take her medicine, eat less, and exercise more? If that had worked, she would not have put herself out there like that in an effort to reach out for help that was going to work.

If you have not taken the time to refer your PCOS patient to a dietitian who can help normalize eating, reduce stress eating and binge eating, and identify other barriers to success that may help that patient succeed with you on a much lower dose of metformin, you may be missing the point. You may also be sending some of your business to someone who"gets it".

Please consider referring to one of our team. We're not trying to be argumentative by pointing this out in this blog post, just sending a friendly reminder that in our world of health care, the definition of insanity just might be prescribing larger and larger doses of a medication that didn't work the first time around…and expecting a different response.

We understand the health care system is set up to keep you from having a lot of time to talk to your patient about what's really going on, like how she's bingeing every time she has a negative pregnancy test, or looks in the mirror and sees new hair growth. We even understand that you're trained to look at numbers and not feelings. That's ok. That's why we started inCYST, so we could attend to the parts of the picture you cannot or do not wish to address. Please think of us as your support staff.

Thanks for hearing me out, and we look forward to helping guide you and your PCOS patients to treatment success.

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A note to physicians prescribing metformin to women with PCOS + women's health