From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
- 1 Adult Dosage Metformin Hydrochloride Tablets The recommended starting dose of metformin hydrochloride tablets are 500 mg orally twice a day or 850 mg once a day, given with meals. Increase the dose in increments of 500 mg weekly or 850 mg every 2 weeks on the basis of glycemic control and tolerability, up to a maximum dose of 2550 mg per day, given in divided doses.
The dose of metformin for PCOS is not explicitly stated in the label, but the recommended starting dose for adults is 500 mg orally twice a day or 850 mg once a day. The dose can be increased up to a maximum of 2550 mg per day based on glycemic control and tolerability. 1
From the Research
The recommended metformin dose for PCOS treatment is 1000-2000 mg/day, which may help reduce the rate of miscarriages and improve fertility outcomes, as supported by the most recent study 2. The typical metformin dose for PCOS treatment ranges from 1000 to 2000 mg daily, usually divided into two or three doses. Treatment typically begins with a lower dose of 500 mg once daily with a meal, gradually increasing over 2-3 weeks to minimize gastrointestinal side effects like nausea, diarrhea, and abdominal discomfort.
- The extended-release formulation, taken once daily with the evening meal, may cause fewer digestive issues.
- Metformin works in PCOS by improving insulin sensitivity, reducing insulin levels, and potentially lowering androgen production, which helps regulate menstrual cycles, improve ovulation, and reduce symptoms like acne and excess hair growth.
- It may take 3-6 months to see full benefits.
- Metformin should be taken with meals to minimize side effects, and patients should stay hydrated and avoid excessive alcohol consumption while using it.
- Regular monitoring by a healthcare provider is important to assess effectiveness and adjust dosing as needed, as suggested by 2, which is the most recent and highest quality study on this topic.
- A combination of metformin with clomifene citrate is more effective than either alone and is a useful option in women with clomifene-resistant PCOS, as reported in 2.
- However, combining metformin with letrozole is not more effective than letrozole alone, as noted in 2.
- Metformin has an adjunctive role in women with PCOS receiving assisted reproduction technology (ART) using the long gonadotrophin-releasing hormone agonist protocol, where it appears to increase the pregnancy rate and to reduce the risk of ovarian hyperstimulation syndrome, as found in 2.