Polycystic Ovarian Syndrome (PCOS) is often considered an issue with the ovaries, when perhaps it should be more accurately categorized as a metabolic disorder.
As many as 65-70% of women who have PCOS also have insulin resistance – a condition that leads to chronically elevated blood sugar levels and leaves one vulnerable to the development of type 2 diabetes and other inflammatory conditions like (you guessed it!) PCOS.
Insulin resistance requires management with diet & lifestyle modifications or treatment with supplementation to prevent complications. It is important that every woman with PCOS get screened for insulin resistance.
So that you can further understand the connection between insulin resistance and PCOS, lets breakdown each condition separately and then we’ll discuss how they relate.
ABOUT PCOS
PCOS is a condition that affects a woman’s hormone levels. Women with PCOS produce higher-than-normal amounts of androgens (male hormones). This leads to a variety of symptoms, including:
• Cysts in the ovaries
• Irregular menstrual periods
• Hair growth on the face and body
• Hair loss on the head
• Weight gain
• Infertility
• Acne on the jawline
This condition affects approximately 1 in 10 women.
ABOUT INSULIN RESISTANCE
Insulin resistance is a condition wherein the cells become resistant to insulin-signalling and the ability to uptake glucose into the cell is diminished.
How does this happen?
The pancreas typically secretes insulin in response to increased blood levels of glucose, a small sugar molecule. When we consume carbohydrates, the glucose molecules enter our bloodstream within approximately 15 minutes. Insulin shuttles that glucose into cells throughout the body so that they can use it to create energy. Whatever glucose the cells cannot take will be shuttled into muscles as glycogen or into fat cells for storage.
When we chronically spike our blood sugar and we are constantly producing insulin, the cell’s receptors to insulin become tired and less responsive. Think of insulin like that family member who drops by way too frequently, unannounced with cookies and cakes; as much as you love that family member, if she pops by too often you’re going to need a break and you might stop answering the door. That is what the cells do. They dull insulin receptors so that they don’t answer the door.
When the cells become resistant to insulin, we end up with high blood sugar levels and no place for that glucose to go except for fat storage. This is where the link to weight gain comes in. Our bodies also don’t like to take no for an answer so we produce even more insulin to try and force glucose into the cells. Essentially, that family member starts knocking on the door even louder, which only further makes you want to sneak out the back door or pretend you’re not home. This is when we reach a state of hyperinsulinemia and the cells become even more resistant.
Essentially, when someone has insulin resistance, the body does not respond to insulin as efficiently, leading high glucose levels in the blood and reduced energy production. With time, larger and larger amounts of insulin are required before glucose is taken into the cells. Eventually, the body begins to deal with sugar differently.
THE CONNECTION
Insulin resistance is now considered a significant root cause for PCOS, which explains the connection between both conditions and the development of type 2 diabetes and obesity.
Elevated insulin levels is a contributing factor to the inflammation and metabolic complications seen in PCOS.
Hyperinsulinemia (an ongoing state of excess insulin production) appears to be an important factor in the development and maintenance of the hyperandrogenemia (an ongoing state of excess androgen production) seen in PCOS. Insulin acts directly to induce excess androgen production by theca cells and also as a co-gonadotropin, augmenting the effect of the increased luteinizing hormone (LH) stimulus seen in the majority of women with PCOS, leading to further excess testosterone production.
The elevated insulin levels may also affect the central actions of androgens in impairing progesterone inhibition of the gonadotropin-releaseing hormone (GnRH) pulse generator, required for optimal hormone production, maintaining a cycle that promotes normal reproduction function.
Simply put, the excess insulin production that occurs with insulin resistance leads to an overproduction of male sex hormones and an over-production of luteinizing hormone, which lead to the suppression of female sex hormones and halt ovulation causing all symptoms associated with PCOS.
SCREENING
Again, it is highly recommended that women with PCOS be routinely screened for insulin resistance so that it can be identified early and promptly addressed.
Tests used to screen for insulin resistance include:
• Fasting blood glucose test: You will be instructed to fast for a specific amount of time before your blood is drawn to check your blood sugar levels. If your levels are elevated, you may be referred to further testing to determine how your body is processing sugar.
• Glucose tolerance test: Your blood will be drawn to test for blood sugar levels. Then, you will be given a drink containing sugar and your blood will be tested again at designated intervals to see how long it takes for your cells to process the sugar. If your glucose levels remain elevated for longer than normal, this may indicate insulin resistance.
• Glycosylated hemoglobin A1C: This is a blood test that measures your average glucose levels over the past three months.
CONSIDERATIONS
Insulin resistance and diabetes can be managed. Steps can be taken to identify insulin resistance before diabetes occurs. If you have PCOS, some healthy diet & lifestyle habits can help prevent diabetes long before tests would be expected to show abnormalities. These steps may also help to address the symptoms of PCOS itself.
Incorporating daily exercise into your routine, eating a well-balanced diet, and certain dietary supplements may help reduce the expression of insulin resistance and PCOS. Check in with your naturopath and nutritionist today to create a plan that is right for you.
SOURCES
Dunaif, A, et al. “Excessive Insulin Receptor Serine Phosphorylation in Cultured Fibroblasts and in Skeletal Muscle. A Potential Mechanism for Insulin Resistance in the Polycystic Ovary Syndrome.” The Journal of Clinical Investigation, U.S. National Library of Medicine, Aug. 1995, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC185266/.
Dunaif, A. “Insulin Resistance and the Polycystic Ovary Syndrome: Mechanism and Implications for Pathogenesis.” Endocrine Reviews, U.S. National Library of Medicine, Dec. 1997, https://www.ncbi.nlm.nih.gov/pubmed/9408743.
Krsmanovic, Lazar Z, et al. “The Hypothalamic GnRH Pulse Generator: Multiple Regulatory Mechanisms.” Trends in Endocrinology and Metabolism: TEM, U.S. National Library of Medicine, Oct. 2009, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769988/.
Marshall, John C, and Andrea Dunaif. “Should All Women with PCOS Be Treated for Insulin Resistance?” Fertility and Sterility, U.S. National Library of Medicine, Jan. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277302/.
Nestler, J E, et al. “Insulin Stimulates Testosterone Biosynthesis by Human Thecal Cells from Women with Polycystic Ovary Syndrome by Activating Its Own Receptor and Using Inositolglycan Mediators as the Signal Transduction System.” The Journal of Clinical Endocrinology and Metabolism, U.S. National Library of Medicine, June 1998, https://www.ncbi.nlm.nih.gov/pubmed/9626131/.
Nestler, J E, et al. “Insulin Stimulates Testosterone Biosynthesis by Human Thecal Cells from Women with Polycystic Ovary Syndrome by Activating Its Own Receptor and Using Inositolglycan Mediators as the Signal Transduction System.” The Journal of Clinical Endocrinology and Metabolism, U.S. National Library of Medicine, June 1998, https://www.ncbi.nlm.nih.gov/pubmed/9626131/.