PCOS AND TYPE 2 DIABETES…WHAT’S THE CONNECTION?

September is Polycystic Ovary Syndrome Awareness Month. Polycystic Ovary Syndrome or PCOS is a hormonal imbalance affecting women in their childbearing years. It causes many unpleasant symptoms and is a leading cause of infertility. According to the Centers for Disease Control (CDC), approximately 5 million women suffer from the syndrome and its lifelong health effects.

PCOS and type 2 diabetes (T2D) have many similar traits including obesity and insulin resistance. They are both characterized by abnormal hormone levels which appear to have a cause-and-effect relationship. In this article, we will look at the PCOS and T2D connection.

WHAT IS PCOS?

PCOS is a hormonal disorder where the ovaries produce too much of the male reproductive hormones called androgens, of which testosterone is the main one. The exact cause is unknown. Theories suggest it may arise from changes in the ovary, alterations in the glands that produce the hormones, or in the brain where hormone production is controlled.

Normally, women have small amounts of androgens, or testosterone in their body, however, with PCOS abnormally high levels are present. Elevated testosterone in women interferes with ovulation and can cause menstrual cycles to become irregular or stop.

For some women, ovulation doesn’t happen at all, and for others, it is inconsistent. In addition to the elevated androgen levels in PCOS, there is also an absence or shortage of follicle-simulating hormone (FSH), necessary for egg development and ovulation. These and other hormonal imbalances contribute to the infertility struggles that women with PCOS face.

WHAT ARE THE SYMPTOMS?

Symptoms vary with the individual and the degree of hormonal imbalance. Not all women have the same experience. Common symptoms include:

-Irregular or absent menstrual cycles

-Ovarian cysts

-Oily skin

-Acne, including on the chest and back

-Excess facial and body hair

-Thinning or hair loss

-Weight gain, particularly around the abdomen

-Depression and mood changes

-Infertility or miscarriages

WHAT IS THE CONNECTION WITH TYPE 2 DIABETES?

PCOS and T2D share hormone abnormalities that affect blood glucose levels. In women with PCOS, elevated testosterone is responsible for the signs and symptoms associated with PCOS as well as contributing to a rise in insulin. In addition, many women with PCOS have insulin resistance, where cells cannot utilize insulin effectively, and blood sugar levels remain elevated. In response, the pancreas produces more and more insulin, trying to move glucose out of the blood. Unfortunately, these high insulin levels tell the ovaries to produce more hormones and testosterone, creating a vicious cycle.

Studies find women with PCOS go on to develop T2D at a younger age than other women. Obesity is seen in nearly 70% of women with PCOS and is one of the most common pathways to T2D. Screening for T2D is recommended for women diagnosed with PCOS, and subsequently, every 1–3 years.

Additionally, high levels of insulin can increase appetite, leading to weight gain, and an accumulation of fat stores in the abdominal area. This visceral fat is unhealthy. It influences insulin resistance, and statistics show women with PCOS experience a higher incidence of heart disease and stroke.

DIAGNOSING PCOS

Many women do not know they have PCOS until they experience difficulty becoming pregnant. There is not one single diagnostic test. Instead, it is diagnosed based on the signs and symptoms a woman experiences, as well as her family history and genetics. Women are at a higher risk of developing PCOS if a primary female relative, such as a mother or sister, has the syndrome.

A physical exam may be followed by a sonogram of the ovaries to check for cysts or other irregularities. In addition, blood tests may be done to check for abnormal hormone levels, as well as blood sugar and cholesterol levels commonly elevated in women with PCOS.

DIET CAN HELP

Many women with PCOS are overweight. Following a healthy diet and losing weight can ease symptoms and improve blood sugar levels. Even a 5% weight loss can make a difference.

To follow a healthy diet:

-Increase consumption of non-starchy vegetables, such as greens, tomatoes, zucchini, broccoli, brussels sprouts, green beans, mushrooms, celery, and carrots to name a few.

-Choose lean proteins including skinless chicken breast, white turkey meat, fish, water-packed tuna, low-fat cheese, yogurt, and tofu.

-Select healthy fats such as olive oil, avocado, walnuts, chia seeds, and flax seeds.

-Increase fiber by choosing whole grain bread and cereals, brown rice, and whole wheat pasta.

-Reduce intake of fried foods, fast foods, chips, pre-packaged snacks, and baked goods.

-Be aware of portion sizes. Use smaller plates. Measure.

-Eat mindfully. Slow down and enjoy each bite.

OTHER TREATMENTS

EXERCISE

Exercise is an important part of PCOS treatment. It helps utilize calories and promote weight loss. Exercise also helps to decrease insulin resistance and improve blood sugar levels.

To be most effective, exercise should be regular and consistent. Making it part of a daily routine and choosing something enjoyable, helps to keep it from becoming a chore. Walking is a good place to start for most people, starting slowly and increasing over time. Setting realistic goals and celebrating each successful step can help to stay motivated. Any physical activity is better than none. Consider taking the stairs instead of the elevator and parking further from the door when shopping.

MEDICATION

For some women, medications may be prescribed, such as birth control pills, and hormones, which act to reduce symptoms and help regulate menstrual cycles. Diabetes medications, such as Metformin may be used to treat elevated blood sugar levels and help to reduce the onset of diabetes.

PROCEDURES

Other medications and procedures, such as in-vitro fertilization or IVF, may be recommended for those women with fertility problems. Surgery is an option for some.

THE TAKEAWAY

Many women with PCOS have insulin resistance and are overweight; two risk factors for developing T2D. It is important that treatment is sought as soon as symptoms appear. Early intervention can improve symptoms, lower the risk for diabetes and help to correct fertility issues.

Once diagnosed, following a healthy diet to reduce weight and adding daily exercise are key steps to feeling better and managing this syndrome. It is important to stay vigilant with treatment plans, and routine doctor visits, to monitor blood sugar levels.

The PCOS Awareness Association helps to provide public awareness and support for women suffering from PCOS. Their website can be found at www.pcos.org. There are also local meet-up groups in the DMV area that provide events and connect women with others who want to share their experiences.