PCOS, Diabetes, & Insulin: How They are Connected
In recent years, it has become clear that PCOS is closely related to a problem with insulin. Although experts haven’t been able to determine whether insulin is the cause of PCOS in some women or if PCOS leads to problems with insulin, one thing is certain: women with PCOS often have issues with insulin resistance. In fact, one study found that as many as 30% of PCOS patients sufferer from insulin resistance, leading many to theorize that perhaps insulin resistance is the underlying cause of PCOS.
What is Insulin?
Insulin is a hormone released from the pancreas after a meal and regulates carbohydrate metabolism. When you eat carbohydrates, your body breaks the carbohydrates down and converts it into glucose, a form of sugar that gives your body energy. As your body produces glucose, it also begins to create insulin, which works to move glucose around to different areas of your body.
Insulin Resistance and PCOS
In women affected by PCOS, there is often a 'resistance' of cells in the body to insulin. As a result, the pancreas makes more insulin to try and compensate. The excessively high levels of insulin can lead to a condition known as hyperinsulinemia, which can cause further health problems. However, elevated levels of insulin can also have an effect on the ovary, preventing ovulation and causing a rise in androgen (testosterone) levels. It is this increase in androgens that affect PCOS sufferers, causing a number of PCOS symptoms.
One study found that 30% of slim women with PCOS have insulin resistance, however it affects as many as 75% of those who are overweight. This explains why overweight women with PCOS are more likely to suffer with excessive hairiness and infertility related to not ovulating.
Longer-Term Risks of PCOS
The long-term risks of PCOS are related to both the insulin problem and the high androgen levels. High levels of insulin are associated with an increased risk of developing type II diabetes which, if it develops, generally means strict diet control or possibly tablet medication. 25-35% of overweight PCOS women show signs of this by their 30's and it probably becomes more common in the 40's and beyond.
The hormone changes described increase the chance of developing high blood pressure and high cholesterol levels, both of which can lead to a greater risk of heart disease.
Irregular or infrequent periods over a long period of time lead to an increased risk of cancer of the lining of the uterus (endometrial cancer). This is, in part, due to high levels of the hormone oestrogen, which over-stimulates the lining of the uterus. Absence of ovulation, and the resulting progesterone deficiency, also contributes to this risk.
Can Anything be Done About It?
Although knowledge is still somewhat lacking in this field, it is believed that the use of Metformin may be of benefit to women with PCOS and insulin resistance. Metformin works to control the production of glucose, thereby reducing your need for insulin. As a result, androgen levels are controlled leading to fewer hormone-related PCOS symptoms as well as increasing your fertility.