Ask Dr Miriam

Q My daughter’s had difficulty getting pregnant. Her doctor says she’s got polycystic ovaries so he’s given her a diabetes drug which seems strange to me. Can you explain?

A The most dramatic feature of polycystic ovary syndrome (PCOS) is difficulty in conceiving and the appearance of masculine features such as facial hair. There’s nearly always substantial weight gain as well.

The root of the condition, however, isn’t in the ovaries. PCOS is a symptom of a deeper disorder – a worsening insensitivity to the hormone insulin which controls our blood sugar. With insulin resistance you get weight gain and obesity. But you also get raised insulin levels, the body’s attempt to overcome the resistance. Insulin is a growth factor and stimulates the production of male hormones, hence the appearance of facial hair and difficulty in conceiving. The antidiabetic drug metformin helps to reverse insulin resistance, as does even modest weight loss. This also results in an improvement in all other features of the condition, including fertility. So along with taking the metformin your daughter should do her utmost to try to lose a bit of weight too.