The PCOS/Diabetes Connection

Insulin resistance common thread of disorders.

Theresa GarneroBy Theresa Garnero, APRN, BC-ADM, MSN, CDE

What causes women to have missed or irregular menstrual cycles; several small ovarian cysts; insulin resistance; difficulty getting pregnant; too many "male hormones;" male-pattern baldness or thinning, or conversely, excessive hair growth on the face, chin, chest, stomach, back, thumbs or toes; weight gain; or acne?

Did someone say chocolate? Wrong!

These events are some of the symptoms of a poorly named syndrome of unknown origin called Polycystic Ovary Syndrome, or PCOS. The namesake of PCOS has to do with the multiple cysts that form when the ovary doesn't make all the hormones needed for an egg to mature. The follicle starts to grow and builds up fluid, but stays in a cyst-like state. After many months of this pattern, the ovaries end up with many cysts. But it's much more than that!

What is PCOS?
The predominant theory is that PCOS is an insulin resistance spectrum of disease (like diabetes). As insulin levels rise to compensate for the body's resistance, ovarian androgen production increases (known as "male hormones" but women make them too), eggs don't mature, and more cysts are born. Other abnormalities associated with PCOS may also include high cholesterol, high blood pressure, acanthosis nigricans (dark brown patches of skin most commonly found on the neck), pelvic pain, and sleep apnea. All of the symptoms are due to excess androgens.

It is one of the most common endocrine disorders in young women affecting about one in ten of childbearing age with symptoms peaking typically between ages 15 and 25. More than half of the women with PCOS will have prediabetes or type 2 diabetes before the age of 40. This syndrome affects lesbian women at higher rates than heterosexual women. (1) PCOS is a serious condition. According to the U.S. Department of Health and Human Service's Office on Women's Health, women with PCOS have 4 to 7 times higher risk of heart attack than those of the same age without it.

Diagnosis is made by putting the diagnostic puzzle pieces together and may include family history, blood glucose and cholesterol levels, blood pressure, weight, body mass index, physical characteristics, symptoms experienced, pelvic exam, and/or a vaginal ultrasound. In addition, some of the biochemical blood abnormalities include high androstenedione levels (sample taken at 9 a.m. on day 21 of the cycle), a luteinizing hormone (LH) that is 2-3 fold higher than the follicle-stimulating hormone level, a low progesterone level, and a mildly elevated or normal testosterone level.

PCOS has no cure but is treated with healthy eating, being active, and taking medications. A weight loss of 10 percent (for those with extra poundage) may restore the menstrual cycle to normal. The management options are tailored to address symptoms and may take a couple of years to be fully effective. To help reduce symptoms of PCOS, diabetes specialists may prescribe Metformin, a drug used to treat type 2 diabetes. PCOS can affect girls as young as 11, and although Metformin is used with children who have type 2 diabetes, it is usually not prescribed for pre-adult girls with PCOS. Women with PCOS may initially be placed on birth control pills (to regulate cycle and manage symptoms) or Metformin.

Women with PCOS who wish to get pregnant need specialized care. Pregnant women with PCOS have higher rates of gestational diabetes, miscarriages, premature delivery, and pregnancy-induced high blood pressure. An endocrinologist would work with a perinatologist to come up with the safest plan (including fertility medications). It is common for women to use Metformin until they become pregnant, and then switch over to insulin (some specialists will work off-label with oral medications such as glyburide).

PCOS & diabetes – they travel in similar circles. Both require perseverance to manage and use of self-care behaviors to maximize health.

1 - Agrawal R, Sharma S, Bekir J, Conway G, Bailey J, Balen AH, Prelevic G. (2004). "Prevalence of polycystic ovaries and polycystic ovary syndrome in lesbian women compared with heterosexual women.". JFertil Steril 82 (5): 1352.

Read Theresa's bio here.

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NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Last Modified Date: July 21, 2014

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by Brenda Bell
Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...
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