Let’s Talk About PCOS and Its Relation to Insulin
An irregular menstrual cycle can mean so much more.
You probably already heard or read something about polycystic ovary syndrome (PCOS) and you’re probably worried about it affecting your reproductive system and chances for pregnancy. Rightly so, since you’re not alone.
All over the world, it is estimated that between 8-20% of all reproductive-age women have PCOS. In the United States alone, it is estimated to have afflicted 5 million women. While most women are diagnosed in their twenties or thirties, girls as young as 11 years old who haven’t had their first period yet can also be affected by PCOS.
What is PCOS?
PCOS is a condition of the female body that affects a woman’s hormone levels. The women afflicted with this condition produce abnormal amounts of male hormones and as a result, the hormonal imbalance causes irregularity in menstrual periods and makes it harder for them to get pregnant.
This condition affects the ovaries, the reproductive organs that produce the hormones that regulate the menstrual cycle – estrogen and progesterone. Male hormones, or androgens, are also produced by the ovaries. The ovaries are also responsible for the release of egg cells that get fertilized by a man’s sperm cells. This releasing of eggs each month is called ovulation.
Women that have PCOS often have tiny cysts (little sacs) on their ovaries, “polycystic” means “many cysts” after all. However, others who share the same condition don’t have any cysts in their ovaries. If you happen to have them, do not be alarmed. These cysts are not harmful and most certainly don’t need to be removed.
These little sacs, while called cysts, are small follicles that contain an immature egg cell. These egg cells never mature enough to trigger ovulation. With ovulation gone, the hormonal levels in the ovaries get altered. Estrogen and progesterone are both being produced lower than what’s normal, and androgen levels are skyrocketing. With the high number of male hormones, the menstrual cycle eventually gets disrupted, causing fewer periods for women with PCOS.
PCOS and Diabetes
It is reported that 65-70% of women afflicted with PCOS are insulin-resistant, which means their bodies can’t use insulin properly. Insulin is a hormone produced by the pancreas that allows the body to use the sugar (glucose) from the food you eat for energy or to store it for future usage. This hormone also regulates your blood sugar level to prevent it from becoming too high (hyperglycemia) or too low (hypoglycemia).
Once your cells can’t use insulin properly, your body calls for more insulin, which the pancreas dutifully fulfills to keep up with the demand. The extra, unused insulin then triggers the ovaries to produce more androgens. Furthermore, your brain, liver, pancreas, heart, and eye cells are in danger of being damaged if your blood glucose levels ran unchecked by insulin.
Researchers in Australia found out that women with PCOS are three to five times as likely to have diabetes than those who have regular menstrual cycles. Also, a research done by the American Diabetes Association found out that 27% of premenopausal women with type 2 diabetes also have PCOS. Both researches stated that obesity was an important trigger.
If you are diabetic and have PCOS, you should coordinate carefully with your doctor since some birth control pills that are used as PCOS medication can increase blood glucose levels. However, some doctors prescribe Metformin, a diabetes medication, even for women with only PCOS and not diabetes.
Causes and Symptoms
As of now, doctors are still unsure as to what causes PCOS in the first place. The excess in androgen production, which causes irregular menstrual cycles, have been linked to genes, insulin resistance, and inflammation. For the latter, there are studies that linked excess inflammation to high androgen levels.
PCOS symptoms vary but the most common manifest either around the time of a woman’s first period or when they’ve gained a lot of weight. The following are some of the most common ones we’ve found:
- Weight Gain – A large majority of women with PCOS, as much as 80% are either overweight or obese.
- Irregular Periods – The absence of ovulation prevents the lining in the uterus from their monthly shedding, resulting to irregular periods. It has been reported that some women with PCOS get less than eight periods a year.
- Heavy Bleeding – This is a direct result of the second symptom. Since the uterine lining builds up over time, the periods that women with PCOS eventually have tend to be heavier than normal.
- Acne – The increase in androgens, the male hormones, can make the skin oilier and cause acne to sprout on areas like the face, back, and chest.
- Hair Growth – Women with this condition often grow hair on their face and body (back, belly, and chest). This condition is called hirsutism. This can also result to male–pattern baldness such as the hair on the scalp getting thinner and sometimes falling out.
- Darkening of the Skin – The high levels of insulin can also cause patches of darkened skin on the back of the neck, the groin area, and under the arms. This condition is called acanthosis nigricans.
How It Affects the Body
Other than the symptoms above, there are also several more serious complications that PCOS might cause due to the hormonal imbalance in the body.
- Infertility – PCOS is one of the leading causes of infertility in women. To get pregnant, a woman needs to ovulate in the first place, thus, women with PCOS, who have irregular periods will naturally have a harder time getting pregnant than those who ovulate normally.
- Depression – The changes in your body and hormones have the potential to negatively affect your mental state. Many women with PCOS experience depression and anxiety due to this.
- Metabolic Syndrome – Since up to 80% of women with PCOS are either overweight or obese, the chances of them contracting metabolic syndrome is much higher. Metabolic syndrome is a group of factors (high blood sugar, high blood pressure, low HDL or good cholesterol, and high LDL or bad cholesterol) that increase the risk of diabetes, stroke, or heart disease.
- Endometrial Cancer – This is a complication of the uterine lining not shedding normally or every month. The resulting build-up can increase the risk for endometrial cancer.
- Sleep Apnea – A condition that is more common in overweight or obese women, sleep apnea causes repeated pauses in breathing during the night.
Diagnosis and Treatment
There are three symptoms that doctors look for when diagnosing PCOS in women. If they have two out of the three symptoms, they will be diagnosed with PCOS:
- Irregular menstrual cycles
- Cysts in the ovaries
- Higher than usual androgen levels
Doctors should also ask if other symptoms like acne, weight gain, and face and body hair have already manifested. As for the cysts in the ovaries, a pelvic exam will be performed by the doctor to check if there are growths in your ovaries or uterus. This can also be performed using an ultrasound.
Another means of diagnosis are blood tests to check for higher-than-normal levels of male hormones. The blood tests can also see your cholesterol, triglyceride, and insulin levels to evaluate if you are at first for diabetes or heart disease.
Other than a healthy diet and an active lifestyle to lose weight, the doctor will also be prescribing medication. This can be birth control pills that can restore normal hormone balance and regulate ovulation. Furthermore, these pills can also relieve symptoms such as excess hair growth and acne.
Metformin, a diabetes medication, can also be prescribed by the doctor to improve your insulin levels. A study found out that taking metformin while having a healthy diet and doing exercise improves weight loss, lowers blood glucose, and normalizes menstrual cycle. Aside from that, you can also take herbal supplements for diabetes. These herbal supplements are likely to have bitter gourd, a superfood that contains plant insulin.
If all else fails, surgery is the last option for women with PCOS. Normal ovulation will be restored using ovarian drilling, a procedure that makes tiny holes in the ovary using a laser or a thin heated needle.
