Metformin
Treats the insulin resistance underneath PCOS, rather than masking the symptoms with birth control.
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Prescriptions require an online visit reviewed by a U.S.-licensed provider. Compounded medications are prepared by licensed U.S. pharmacies and are not FDA-approved. Individual results vary.
Who it’s for
- Perimenopause or menopause symptoms (sleep, hot flashes, mood)
- PCOS, irregular cycles, or hormonal acne
- Want care from clinicians who order labs before prescribing
Nobody ever told you the acne and the weight were the same conversation.
what the first months look like
Bloodwork first — kidney function and potassium decide whether and where spironolactone starts. No labs, no fill.
Adjustment. Spironolactone is an aldosterone antagonist, so expect more bathroom trips; metformin typically introduces itself through the gut. Both usually settle.
The hormonal signal shifts before the mirror does. Hormonal acne and cycle patterns respond on the timescale of cycles, not days — patience is part of the protocol.
Repeat labs and dose titration at check-ins. The dose you end on is measured against your potassium and your response, not guessed.
Dosing, step by step
| Spironolactone | 50–100 mg daily — titratable to 200 mg based on response and labs (per ingredient profile) |
|---|---|
| Metformin | Clinician-set, titrated gradually — slow up-titration with food is how GI side effects are kept small (textbook; no ingredient profile on file) |
| Inositol (optional) | Per clinician — an add-on, not a requirement; no ingredient profile on file |
Labs before and during — potassium and kidney function set the spironolactone dose. Holding a dose or stepping down is routine, not failure.
And when it gets rough
- Increased urination Spironolactone is an aldosterone antagonist with a diuretic effect. Front-load fluids earlier in the day; it tends to ease as your body adapts.
- Menstrual irregularity Common on oral spironolactone. Log your cycle and bring it to check-ins — it's a dosing input, not just a nuisance.
- GI upset (metformin, early) Take with food and let the slow titration do its job. Persistent trouble is a dose conversation with your clinician, not something to push through.
- Dizziness Stand up slowly and hydrate. Muscle weakness, palpitations, or dizziness that doesn't pass is a same-day clinician call — potassium gets checked, not guessed.
Most women with PCOS get handed birth control and sent on their way — it quiets the symptoms without touching what's driving them. We start here instead because metformin works on the insulin resistance and spironolactone on the androgen excess, which is the actual pair of problems sitting under the acne, the irregular cycles, and the weight that won't move. We want bloodwork before we begin — spironolactone can shift your potassium, and we won't dose it blind — and we tell people the stomach side of metformin usually settles over the first few weeks if we go slow. Give it time on the mirror: the cycles tend to find their rhythm before the skin does.
Three steps, no insurance hoops
Take the quiz
Two minutes. Tell us your symptoms, history, and goals.
Clinician reviews
A U.S.-licensed clinician reviews and writes your plan within 24 hours.
Care ships free
Your medication arrives in days. Refills auto. Check-ins included.
see it in real life
What members say
4.5Absolutely love Zappy Health. Very professional, customer service is amazing. Fast shipping and everything is certified. Zappy Health has transformed my life. I am in the best shape with my health! Thank you Zappy Health for helping me achieve my goals on a wellness journey.
Zappy Health is extremely easy to enroll in. They were helpful every step of the way & I knew within the hour of submitting my application that I was a candidate. As soon as I made my decision to start my journey the communication from them has been impressive.
The initial process of ordering the medication was extremely easy. The app is very helpful and I cannot wait to receive my medication and start my journey. Thank you so much!!
Verified Trustpilot reviews, published as written. Individual results vary and are not typical.
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