Metformin is the most commonly prescribed medication for PCOS after birth control. It's an insulin sensitiser, originally developed for type 2 diabetes.

How it works: Metformin reduces glucose production in the liver and improves how cells respond to insulin. By lowering insulin levels, it indirectly reduces ovarian androgen production.

What it can improve:

• Insulin resistance and fasting insulin levels • Menstrual regularity (though less effectively than birth control) • May reduce androgen levels modestly • Small amount of weight loss in some people (average 2-3 kg) • May improve ovulation, especially combined with lifestyle changes

The GI side effects reality: Metformin's biggest challenge is gastrointestinal side effects, especially when starting. Tips that help:

• Start at a low dose (500mg) and increase gradually over 2-4 weeks • Always take with food • Extended-release (ER/XR) formulation causes significantly fewer GI issues than immediate-release • Side effects often improve after 2-4 weeks as your body adjusts • If standard metformin is intolerable, ask your doctor about the extended-release version

Important notes: • Community rating: 7.6/10 average among people with PCOS • Generally safe long-term; has been used for decades • Can deplete vitamin B12 over time — get levels checked annually • Stopping metformin usually means symptoms return • Safe during pregnancy (discuss timing with your doctor)