In pcos what is the dose of metformin

The recommended dose of metformin for managing polycystic ovary syndrome (PCOS) in clinical practice is typically initiated at 500 mg once or twice daily, with gradual titration to a maintenance dose of up to 2 grams daily as tolerated. This dosing mirrors that used in type 2 diabetes management, aiming to minimize gastrointestinal side effects while achieving metabolic and hormonal benefits.

Metformin is used off-label for PCOS in the UK, and its use is particularly considered in women with a body mass index (BMI) ≥25 kg/m2 who have metabolic risk factors such as impaired glucose tolerance or belong to high-risk ethnic groups, alongside lifestyle interventions.

Combination therapy with combined oral contraceptives (COCs) may be considered when lifestyle changes and COCs alone do not adequately manage metabolic features.

Patients should be informed about the off-label status of metformin for PCOS, potential adverse effects including gastrointestinal symptoms and vitamin B12 deficiency, and the need for ongoing evaluation of treatment necessity.

While no specific randomized controlled trials define an exact dose for PCOS, the dosing approach is consistent with that for type 2 diabetes, starting low and titrating up to improve tolerability and efficacy.

Recent systematic reviews and meta-analyses support metformin’s role in improving metabolic and hormonal outcomes in PCOS, particularly in high metabolic risk groups, without recommending a different dosing regimen from diabetes management.