PCOS metformin and prolactianemia

  hi .
i have been confused since my last visit to my endo , till then i was thinking i have to be insulin resistant to have pcos , but he told me according to my records  it wasnt the case for me ( i remember having some hormone tests back then but cant remember if i had insulin test with them .)  what i wonder is can my PCOS related to my prolactianemia caused but pitituary microadonema only without insulin issues? .  if thats the case why they want me to use metformin  and it is helping me get  28 days cycles with the cabergoline i use for prolactinemia  (if i only use cabergoline  its around 33-38 and if i dont use any meds its 40 + days or  it may skip some months  )  i thought metformin only helps if things are insulin related )   . or does it work in any other way independent from insulin relations on ovulation ?  ( i think i have seen some use of it in fertility treatments like IVF but not sure if its for pcos people or everyone )
   thanks

[Elaine Brown, MD]

Hi!
Your pituitary microadenoma is definitely throwing your cycles off--that is why they are so long (lots of people don't have any!) without meds.  I also thought that metformin helpeed ovulation by improving insulin sensitivity.  In order to check if you are insulin resistant, you need to have insulin levels done.  You don't necessarily have to have abnormal blood sugars.
The fact that the metformin makes your cycles regular suggests to me that you ARE insulin resistant.  You could ask you RE if it is being used to further suppress you prolactin, but the Cabergoline should be doing that job.

I am confused along with you! We do use metformin in infertility, but we use it (as far as I know) to improve insulin sensitivity and increase ovulation rates.  PCOS as you are probably aware is a catch-all term for irregular periods.  You don't even have to have cysts to have PCOS!

I'm sorry I was not more helpful--ask your RE again--you may be smarter than he/she is!

Good luck!
Dr B