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The Link Between PCOS and Diabetes

Polycystic ovary syndrome is associated with increased risk for diabetes. Here, learn why that is — and how you can help prevent it.

With Casey Means MD

1 in 10 women of childbearing age have PCOS.

Polycystic ovary syndrome (PCOS) is a hormonal condition that involves frustrating issues caused by the circulation of too many androgens, which are male hormones (think testosterone).

PCOS is also linked to health complications such as diabetes, so it’s important to understand the condition itself as well as any concurring or potential issues that can develop.

It's relatively common, occurring in around 1 in 10 women of childbearing age. So, if this is you, you’re not alone. 

Symptoms

  • Irregular menstrual cycles. PCOS causes irregular periods, fewer periods, or no periods at all.
  • Hair growth, or hirsutism, which is a growth of dark, coarse hair. Women may experience hair growth in places like the face, chin, or chest.
  • Hair thinning or hair loss. You might find that your hair loss mimics male pattern baldness.
  • Pelvic pain.
  • Infertility or problems getting pregnant.
  • Weight gain or difficulty losing weight. Some women with PCOS may also experience weight loss.
  • Acne on the chest, chin, back, or other areas of the face. Also, skin darkening may occur, especially in creases like the armpits and groin.
  • Depression or anxiety. About 50 percent of people with PCOS report mood changes.

Unfortunately, that’s not all. PCOS is associated with additional issues.

According to Casey Means MD, editor of the International Journal of Disease Reversal and Prevention, and chief medical officer and co-founder of Levels, other issues with PCOS include “increased visceral fat (fat around organs) and subcutaneous fat (fat under the skin).”

If you have PCOS, you may also be at risk for cardiac issues, high blood pressure, high cholesterol, impaired glucose tolerance, hyperinsulinemia (or excess levels of insulin),  and, again, prediabetes or type 2 diabetes (more on that below).

Diagnosis

To be diagnosed with PCOS, your healthcare provider will likely run a few tests (these may include a pelvic exam, an ultrasound, and a blood test) and ask you several questions about your health and your family’s health history. There is no one single test that can help determine PCOS, so expect a pretty thorough investigation.

“There are multiple diagnostic criteria systems for PCOS,” Dr. Means says, “but the diagnosis generally includes some combination of abnormal menstruation, clinical signs of high androgen levels, and polycystic ovaries seen on an ultrasound.

How PCOS can lead to prediabetes and diabetes

PCOS is challenging enough as it is, so it’s important that you care for your body to prevent or manage further health issues such as diabetes. Diabetes is a disease that occurs when your blood glucose, or blood sugar, is too high. This causes insulin resistance, due to your body being unable to use all of that glucose for energy.

According to Mark P. Trolice MD, Director of Fertility CARE, up to 40 percent of women with PCOS could develop prediabetes (or very high blood sugar). Many patients with prediabetes are overweight, he says. Up to 10 percent of patients with PCOS will develop diabetes.

But why is PCOS associated with diabetes? It’s complicated, but it’s important to understand. Dr. Means explains that it’s the elevated testosterone levels leading to insulin resistance which could be the culprit.

Causes

When hormones such as testosterone are very high, it stimulates insulin production, which then causes insulin resistance and hyperinsulinemia — both of which are responsible for the potential development of prediabetes and type 2 diabetes.

The connection between PCOS and prediabetes is bidirectional, she continues: “It appears that high levels of insulin are not only a side effect of PCOS, but also likely play a role in causing and maintaining PCOS.” Which means that it’s a vicious cycle.

Those high insulin levels then stimulate the ovaries to produce more hormones such as testosterone. This, in turn, then leads to issues like hair growth, irregular menstrual cycles, and weight gain.

The insulin also worsens PCOS, Dr. Means says. “Insulin directly causes specialized cells in the ovary called theca cells to produce androgens. Insulin can also trigger an increase in the actual number of theca cells within the ovary, thereby increasing the capacity of the ovaries to produce androgens.”

High levels of insulin can also decrease the production of something called the sex hormone-binding globulin (otherwise known as SHBG), which further leads to high levels of male hormones.

And the weight gain many people with PCOS struggle with? Insulin can actually increase your appetite (and it can make sweet foods taste even sweeter — increasing the desire to eat more). It also “impairs fatty acid oxidation, making it more difficult to burn fat and may contribute to weight gain,” Dr. Means says.

PCOS and gestational diabetes

It’s important to note that PCOS can also lead to gestational diabetes, which occurs when women develop glucose issues during pregnancy. This can cause birth complications such as premature birth, breathing issues, jaundice, and more.

It’s important to work with your healthcare provider during pregnancy so that you can find the lifestyle habits and foods that will keep you as healthy as possible.

Treatments

There is no cure for PCOS, according to Dr. Trolice, but treatment is possible. If all of this sounds overwhelming to you, know that there are ways to manage the condition. It may take time, effort, and a recalibration of your lifestyle habits, but it can happen.

First, your healthcare provider may prescribe medication — such as birth control pills, creams, or other medications — to help treat the symptoms, including hair growth and high hormone levels. But you play a key role in your own health, too, so treat yourself with compassion and patience.

The goal, Dr. Trolice says, is serious lifestyle management, including weight loss — which may help restore your periods and ovulation cycles to normalcy. “Appropriate weight loss is the first approach to potentially restore ovulation and reduce the medical complications of PCOS,” he says.

To lose weight, you’ll want to start in the kitchen — and go from there. Dr. LaKeischa, an integrative gynecologist, recommends eating a few frequent meals throughout the day — rather than two or three huge meals — so that you don’t experience insulin spikes.

You’ll want to reach for plant-based, unrefined foods. The fewer ingredients a particular food has, the better. Pro-tip: Shop the perimeter of the grocery store, aiming for fresh foods rather than boxes and bags found in the middle.

Dr. Means says there’s a lot of evidence that both low-glycemic and ketogenic diets may improve insulin sensitivity, glucose levels, and hormone imbalance. She stresses, however, that each person is different. Your sleeping patterns, genetics, stress levels, and exercise habits are all crucial variables that play into your unique response to diet or treatment.

For that reason, she says, “There is a promising role for the use of continuous glucose monitors as a metabolic biofeedback tool in PCOS, as this wearable sensor can provide real-time insight about how foods and lifestyle factors impact glucose levels, and allow PCOS patients to tailor their choices to lower their metabolic response.”

Movement matters, too, although more research is needed on what kind of exercise, according to studies. You’ll want to exercise at least 30 minutes each day, Dr. LaKeischa says. “When you exercise, the big muscle groups want to use the food you have eaten as fuel, and when that happens, your body is less insulin resistant.”

Unfortunately, it’s important to know that it can be difficult to lose weight with PCOS. For this reason, try to think of the kitchen and gym as partners. Plenty of studies show the benefits of working out with PCOS, but the weight may still be difficult to shed.

PCOS and fertility

For women trying to conceive, Dr. Trolice says the course of action may include ovulation induction with the use of oral medication. The patient’s age, body weight, and other variables all play into conception. “If she is unable to ovulate with medication, the next steps are laparoscopy or in-vitro fertilization (IVF).”

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