The link between PCOS and Diabetes
Diabetes currently affects over 387 million people worldwide and over half of these people are women. Diabetes can be especially tough on women. The risk of heart disease, the most common complication of diabetes, is more serious among women than men.
Among people with diabetes who have had a heart attack, women have lower survival rates and a poorer quality of life than men. Women with diabetes have a shorter life expectancy than women without diabetes and women are at greater risk of blindness from diabetes than men. Death rates for women aged 25-44 years with diabetes are more than 3 times the rate for women without diabetes.
POLYCYSTIC OVARIAN SYNDROME (PCOS) – THE PARTNER OF DIABETES
PCOS is one of the most common hormonal endocrine disorders in women and the most common cause of female infertility.
The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.
In women with PCOS, the ovary doesn’t make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent. Plus, the ovaries make male hormones, which also prevent ovulation.
As a result, women with PCOS often don’t have menstrual periods or only have periods on occasion. Because the eggs are not released, most women with PCOS have trouble getting pregnant.
The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:
- Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.
- Infrequent, absent, and/or irregular menstrual periods
- Hirsutism (HER-suh-tiz-um) — increased hair growth on the face, chest, stomach, back, thumbs, or toes
- Cysts on the ovaries
- High levels of androgen hormones (such as testosterone)
- Acne, oily skin, or dandruff
- Weight gain or obesity, usually with extra weight around the waist
- Male-pattern baldness or thinning hair
- Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
- Skin tags — excess flaps of skin in the armpits or neck area
- Anxiety or depression
WHAT CAUSES PCOS?
The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.
Most experts agree PCOS is related to body weight, as many women with PCOS are overweight or obese. But if you are overweight, weight loss of just 5 percent can improve PCOS symptoms. Extra body weight might be part of the connection between PCOS and type 2 diabetes, but almost half the women with PCOS are lean, so something’s missing from the story.
Researchers also think insulin may be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen. High androgen levels can lead to: Acne, Excessive hair growth, Weight gain, Problems with ovulation.
HOW IS PCOS DIAGNOSED?
Diagnosing PCOS involves several steps.
Your doctor should gather information about your past and family medical history, including questions about your menstrual cycles in detail, pregnancy history or infertility, weight changes, sleep patterns, fatigue, depression, medications you are currently taking, review of previous blood testing you have had and other medical history.
Your practitioner’s exam will include measuring your blood pressure, weight, and identifying your body mass index (BMI). They will examine your body for any signs and symptoms such as hair growth, skin discoloration, skin tags, acne and thinning hair.
If your doctor suspects you have PCOS, he or she may recommend blood tests to measure hormone levels. Women with PCOS can have high levels of hormones such as testosterone. Your doctor may check your insulin and glucose levels, to look for diabetes or insulin resistance (inefficient use of insulin in the body).
Your practitioner should perform a pelvic ultrasound. This test is performed to take images of the endometrial lining and look for multiple cysts.
Once your doctor makes a diagnosis, you will work together to decide how to best treat and manage your condition.
DOES PCOS PUT WOMEN AT RISK FOR OTHER CONDITIONS?
Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases.
Recent studies found that:
- More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.
- The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.
- Women with PCOS are at greater risk of having high blood pressure.
- Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
- Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.
Cardiovascular Risk Factors and Disease in PCOS
Aside from the increased risk of type 2 diabetes mellitus in PCOS patients, there are multiple other metabolic abnormalities that put them at higher risk for cardiovascular disease. Many, but not all studies have shown either a greater prevalence of diagnosed hypertension or higher ambulatory blood pressure in PCOS. The pattern of dyslipidemia in PCOS is in keeping with Insulin Resistance, increased triglycerides, and low HDL-cholesterol.
Based on the increased prevalence of risk factors in patients with PCOS, studies estimate a 7-fold increased risk of myocardial infarction in these women.
PCOS in Adolescents
Premature pubarche (appearance of pubic hair before age 8) may be an early expression of PCOS and is associated with ovarian hyperandrogenism and the development of chronic anovulation. Increased awareness of PCOS by physicians has and will continue to lead to diagnosis at an earlier age. Many previously mentioned diagnostic and therapeutic issues apply to adolescents with PCOS. Perhaps most alarming is the aspect of Insulin Resistance.
Irregular menstrual periods and the absence of ovulation cause women to produce estrogen, but not progesterone. Without progesterone, which causes the endometrium to shed each month as a menstrual period, the endometrium may grow too much and undergo cell changes. This is a pre-cancerous condition called endometrial hyperplasia which can lead to cancer.
Depression or mood swings also are common in women with PCOS. Although more research is needed to find out about this link, there are studies linking depression to diabetes. Therefore, in PCOS, depression may be related to insulin resistance. It also could be a result of the hormonal imbalances and the cosmetic symptoms of the condition. Acne, hair loss, and other symptoms of PCOS can lead to poor self-esteem. Infertility and miscarriages also can be very stressful. Medications that restore the balance to hormone levels or antidepressants can help these feelings.
Polycystic ovary syndrome treatment starts with a proper diagnosis. Treatments are then chosen based on a woman’s symptoms, age and future pregnancy plans. Treatment for PCOS may include:
Birth control pills to regulate menstruation: To regulate your menstrual cycle, your doctor may recommend combination birth control pills — pills that contain both estrogen and progestin. These birth control pills decrease androgen production and give your body a break from the effects of continuous estrogen, lowering your risk of endometrial cancer and correcting abnormal bleeding.
- Ovulation induction to treat infertility: If you’re trying to become pregnant, you may need a medication to help you ovulate.
- Androgen-blocking medications
- Topical anti-hair-growth medications
- Treatments for hair loss
- Acne treatments
- Removal of other skin problems
Lifestyle and Prevention
One of the best treatments for PCOS is a healthy lifestyle. A healthy diet low in refined carbohydrates is important, as this can help regulate blood sugar levels. Exercise can also help the body regulate insulin and keep excess weight off. Losing weight is challenging with PCOS, but doing so can help reduce the male hormone levels in the body, and some women will begin to ovulate naturally. With a proper diagnosis, lifestyle changes and PCOS treatment, women can get relief from this condition and the overwhelming health problems it can cause.
Dr. Rajiv Kovil
Consultant Diabetologist, Dr. Kovil’s Diabetes Care Centre
Dr. Rajiv Kovil is a Consultant Diabetologist at Dr. Kovil’s Diabetes Care Centre, the first Preventive Diabetes Centre & Diabetic Foot Clinic in Mumbai, KLS Memorial Hospital and Holy Spirit Hospital among others. He is a founder member of United Diabetes Forum, a forum of practising diabetologists in India. He has also written various articles on diabetes for medical journals such as Asian Journal of Diabetology and Medical Image. His Preventive Diabetes Centre & Diabetic Foot Clinic is an initiative to provide preventive diabetic measures as well as to function as a specialized Foot Clinic for diabetic patients not only in terms of equipment but more importantly in terms of expertise.
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