Polycystic Ovarian Syndrome

Introduction

A diagram Polycystic Ovarian Syndrome (PCOS).
Photo Credit to Dee-sign Adobe Stock

Polycystic Ovarian Syndrome (PCOS) and type 2 diabetes are two health conditions that are intricately linked to insulin resistance. According to the Centers for Disease Control & Prevention, insulin resistance occurs when the body is exposed to elevated levels of blood sugar for a prolonged period of time. As a result, the body works harder to lower one’s blood sugar levels by releasing extra insulin. However, over time, the body’s cells stop responding to the insulin secreted and begin to struggle to take up sugar from the blood. This is why insulin resistance is a precursor to type 2 diabetes. In women with PCOS, the increased level of insulin in the body can cause the ovaries to produce more testosterone. This is demonstrated by a noticeable increase in a woman’s serum androgen levels; this testing is done through bloodwork and examines hormone levels that are often associated with male puberty and male-related characteristics. The increase in these male associated hormones, such as testosterone, can contribute to many of the symptoms associated with PCOS, such as acne, unwanted hair growth on the face, back, and chest, and fat storage around the abdomen.

With rates of type 2 diabetes steadily increasing worldwide, it is important for women with PCOS to learn how to manage their symptoms as early as possible. Currently, it is estimated that more than half of women diagnosed with PCOS will develop type 2 diabetes by age 40. As diabetes is a chronic condition that progresses over time, it is important that women with PCOS learn of the connection between PCOS and type 2 diabetes so that they may delay the onset of diabetes for as long as possible.

What is PCOS? Etiology and Symptoms

Polycystic Ovarian Syndrome, also known as PCOS, is one of the leading causes of female infertility, affecting 6% to 12% of US women of reproductive age. Many of those impacted by this condition begin experiencing symptoms as young as 11-12 years old or during the onset of their first menstrual cycle. While the exact cause of this condition is unknown, the most well-known risk factor for developing PCOS includes family history, as women with a mother or sister with the condition are more likely to be diagnosed. As the name states, this condition is a syndrome that can be defined as a classification of symptoms rather than a true disease condition. Because of this, symptoms experienced by those with PCOS vary widely from woman to woman – for example, some women experience all the symptoms of PCOS, while others may only experience a handful of symptoms. Some of the most common symptoms associated with this condition include irregular periods, thinning hair, acne, excess male pattern hair growth on the face and body, polycystic ovaries, and easy weight gain, particularly around the midsection. Because symptoms vary so widely, PCOS can be tricky to diagnose.

Current diagnostic criteria for this condition looks for two out of three major symptoms experienced by most women with PCOS:

1. Irregular periods: caused by ovulatory dysfunction and can lead to missed periods
2. Elevated androgens: sex hormones often associated with male puberty which can cause acne, oily skin and increased body hair
3. Polycystic ovaries: defined as a woman having 12 or more cysts on her ovaries; often identified as a “string of pearls” along the ovaries

It is not uncommon for an endocrinologist to also perform a glucose tolerance test when diagnosing a woman with PCOS to see if she is experiencing insulin resistance.

The Role of Insulin Resistance in PCOS

The role of blood sugar in the management of PCOS is one of the most vital factors to consider. Hyperinsulinemia is the word used to describe high insulin levels in the body. Again, for women who have PCOS they often experience a dysfunction in their ability to utilize insulin properly. Because the body’s cells are not responding to the insulin that is secreted, the pancreas works harder to produce more insulin to balance blood sugar.

However, this is incredibly problematic for women with PCOS as elevated insulin levels directly correlate to other common symptoms experienced. In women, when insulin levels are high, two things commonly happen. First, excess insulin stimulates the ovaries to produce extra androgenic hormones such as testosterone. The excess testosterone then leads to the common male associated symptoms such as male pattern baldness, excess hair growth on the face and body, and acne, especially on the jawline. Second, the excess insulin encourages the body to begin storing fat, which is why many women with PCOS experience weight gain or store weight around their midsection. Unfortunately, this can also lead to other health conditions, as weight around the abdomen puts pressure on our organs, which can lead to complications such as cardiovascular disease.

Given that PCOS is difficult to diagnose, many women look for answers for years before receiving a confirmed diagnosis. This makes early detection difficult, but the sooner a woman can begin implementing a treatment plan, the more likely she can prevent complications such as heart disease and type 2 diabetes.

Complications Associated with PCOS

In addition to the wide variety of symptoms experienced by those with PCOS, there are also many complications and additional symptoms and diagnoses that can occur because of insulin resistance and high androgen levels.

The most common and well-known complication associated with PCOS is infertility. It is estimated that of those women who are anovulatory, a word to describe those who do not have a period, 70-80% of them are “infertile”. For many of these women, additional treatments may be necessary to achieve pregnancy, such as ovulation medications, intra-uterine insemination, and invitro-fertilization. It is important to note that many women with a diagnosis of PCOS will be able to achieve pregnancy without medical intervention. However, for most of these women, strict diet and lifestyle modifications have to be made to address their hyperinsulinemia, insulin resistance, and excess androgenic lab values. However, once a woman achieves pregnancy, her pregnancy is often categorized as “high-risk”. Common potential complications include miscarriage, gestational diabetes, premature birth, and pre-eclampsia. Because of these risk factors, many will need to be followed by a Maternal Fetal Medicine doctor to ensure both the safety of the baby and the mother.

Other common complications and concerns associated with PCOS are:

• Nonalcoholic steatohepatitis – a severe liver inflammation caused by fat buildup in the liver
• Metabolic syndrome – the diagnosis of a cluster of chronic disease conditions such as obesity, high blood pressure, elevated blood lipids, low levels of HDL cholesterol, and insulin resistance.
• Type 2 diabetes or prediabetes
• Sleep apnea
• Mental health disorders, including depression and anxiety
• Endometrial cancer – cancer of the uterine lining

How to Manage PCOS and Prevent Complications such as Type 2 Diabetes

Managing PCOS includes behavioral lifestyle changes such as increased physical activity and eating a balanced diet. Before initiating a new self-care plan, including exercise and dietary changes, one should always consult with their primary care physician to ensure they are done safely. It is recommended that adults strive for 150 minutes of moderate physical activity per week. This helps to keep the cardiovascular system healthy, but regular exercise can also help to sensitize the body to insulin by helping the body utilize excess blood sugar. Other benefits include weight loss, general feelings of wellness, and improved mental health. A balanced diet of whole grains, lean proteins, healthy fats, fruits and vegetables can help manage the symptoms of PCOS and weight gain, which can reduce the risk of developing type 2 diabetes.

Balanced Diet with PCOS

A balanced diet that is blood sugar friendly and anti-inflammatory can be helpful to women with PCOS. Women are encouraged to consume three full meals a day and to space them out every 4-6 hours to prevent blood sugar lows and highs, which will help mitigate insulin spikes between meals and throughout the day. Utilizing The Plate Method can also help with serving and portion sizes. The recommendation is to make half your plate non-starchy veggies, one-quarter of your plate lean protein and another one-quarter starchy carbohydrates, grains, or fruits

These foods are great choices when using The Plate Method at mealtimes:

• Non-starchy vegetables such as leafy greens, broccoli, cucumber, tomato, carrots, brussels sprouts, and summer squash
• Healthy fats such as avocado and olive oil, nuts, and seeds
• Whole grains such as whole wheat bread, brown rice, whole wheat pasta, and oatmeal
• Fatty fish, including salmon and tuna
• Lean proteins such as chicken, turkey, tofu, and lean cuts of beef and pork

Limit these foods:

• Fried foods
• Saturated fats such as butter, lard, coconut oil, and palm oil
• Sweet pastries and desserts such as cakes, cookies, candy, and pies
• Sugary beverages such as sodas, sweetened teas and sports drinks
• Alcoholic beverages
• Refined carbohydrates such as white bread, rolls, pizza crust and pasta

Physical Activity Recommendations

We know that a lack of physical activity and excess body weight are factors contributing to developing insulin resistance with PCOS. Physical activity is beneficial for women diagnosed with PCOS regardless of their weight, and every type of exercise has been shown to be beneficial. The general recommendations for adults include 150 minutes of moderate aerobic activity per week. One way to accomplish this is by exercising for 30 minutes 5x a week. It is also encouraged that women with PCOS engage in resistance or strength activities 2-3x per week to build and strengthen muscles.

Here are some examples of exercises to try:

• Walk for 30 to 45 minutes a day around your neighborhood or on a treadmill
• Take an aerobics class online or at a gym. Examples include step, dance, boxing, or spinning
• Take a HIIT (high-intensity interval training) class online or at a gym
• Practice yoga, Pilates, or tai chi at a studio, gym, or using an online class
• YouTube offers free online workout classes that you can access from your cell phone or any mobile device. However, be sure to follow classes or videos that have been crafted by qualified fitness professionals.

Conclusion

Polycystic Ovarian Syndrome is a complex condition that is often stressful and difficult to manage. It is important for women with this condition to know that making small changes will lead to better health over time. While this is a life-long condition, and changes will need to be maintained, the benefit of making those changes is that those who employ them will live longer, healthier lives.

References:

1. Centers for Disease Control & Prevention. (2024a). About insulin resistance and type 2 diabetes. Retrieved from https://www.cdc.gov/diabetes/about/insulin-resistance- type-2-diabetes.html
2. Centers for Disease Control & Prevention. (2024b). Diabetes and polycystic ovarian syndrome (PCOS). Retrieved from https://www.cdc.gov/diabetes/risk-factors/pcos- polycystic-ovary- syndrome.html?CDC_AAref_Val=https://www.cdc.gov/diabetes/basics/pcos.html
3. Christ, J. P., & Cedars, M. I. (2023). Current guidelines for diagnosing PCOS.
4. Diagnostics, 13(6) doi:10.3390/diagnostics13061113
5. Clevland Clinic. (2022). Hyperinsulinemia. Retrieved from https://my.clevelandclinic.org/health/diseases/24178-hyperinsulinemia
6. Mayo Clinic. (2022). Polycystic ovarian syndrome (PCOS). Retrieved from https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc- 20353439
7. National Institutes of Health. (2024a). What causes PCOS? Retrieved from https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/causes
8. National Institutes of Health. (2024b). What causes PCOS? Retrieved from https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/causes