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PCOS and Diabetes: What’s the Link?

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PCOS and Diabetes: What’s the Link?

Polycystic ovary syndrome (PCOS) is a condition that affects women and is one of the most common causes of female infertility. It also has other longer-term health implications, including type 2 diabetes. Learn more about PCOS and how it’s managed.

What is PCOS?

PCOS affects between 6% and 12% of women of reproductive age in the United States, according to the CDC (Centers for Disease Control and Prevention). An imbalance of reproductive hormones creates problems in the ovaries, which make eggs. If you have PCOS, the eggs may not develop as they should, or they might not be released properly during ovulation.

PCOS can also cause irregular menstrual periods that can lead to infertility and development of cysts in the ovaries.

What causes PCOS?

The exact causes of PCOS aren’t entirely clear, but there are certain factors that can play a role in its development. These include:

High levels of androgens.

Androgens are usually thought of as “male” hormones, but women make small amounts, too. Women with PCOS have more androgens than usual, and this can prevent the ovaries from releasing an egg during menstrual cycles. Excess androgens can also cause extra hair growth and acne.

High levels of insulin.

A lot of women with PCOS are insulin resistant, especially if they have overweight or obesity or a family history of type 2 diabetes. Insulin resistance can lead to type 2 diabetes, as well as other health problems, such as heart disease.

Low-grade inflammation.

Some research shows that women with PCOS have high levels C-reactive protein, or CRP, which is a sign of inflammation. There might be other signs of inflammation, as well, such as high levels of certain types of white blood cells and cytokines. High CRP levels are linked with insulin resistance, diabetes, and heart disease.

Family history.

PCOS can run in the family, which means that women with a mother, sister, or aunt who have PCOS are at risk of developing it themselves.

Who gets PCOS?

The U.S. Department of Health & Human Services’ Office on Women’s Health shares that “Between 5% and 10% of women between 15 and 44, or during the years you can have children, have PCOS.” PCOS can happen any time after puberty, but it’s usually diagnosed when women are having difficulty getting pregnant. PCOS affects women of all races and ethnicities.

What health problems are linked with PCOS?

Having PCOS can put you at risk for certain health problems, including:

What are the signs and symptoms of PCOS?

Signs and symptoms of PCOS may develop around the time of puberty, but they can appear later, too. Symptoms may be more severe with overweight or obesity. Common symptoms include:

  • Irregular menstrual cycles. Some women may stop having periods altogether.
  • Acne.
  • Hirsutism, which is excess hair on the face, chin, or parts of the body where men usually have hair.
  • Hair loss or thinning hair on the scalp (male-pattern baldness).
  • Acanthosis nigricans, which is dark patches of skin in the neck creases, underneath the breasts, and in the groin. This skin condition is common with insulin resistance.
  • Skin tags (small flaps of skin) in the armpits or on the neck.
  • Weight gain or difficulty losing weight.

How is PCOS diagnosed?

There isn’t a single test to diagnose PCOS. However, a doctor will typically review your weight and medical history, including your menstrual history, do a physical exam to check for excess hair growth, acanthosis nigricans, and acne, and possibly order other tests, including:

  • A pelvic ultrasound to check the ovaries for cysts and the thickness of the uterine lining
  • Blood tests to check androgen, glucose, and cholesterol levels, and possibly thyroid hormone levels, too

PCOS is diagnosed if you have at least two of these symptoms:

  • Irregular periods
  • Signs of excess androgens, such as acne and excess hair growth
  • High androgen levels
  • Multiple cysts on one or both ovaries

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How is PCOS treated?

PCOS can’t be cured, but it can be treated with medications and lifestyle changes. If you would like to become pregnant, your doctor may prescribe medication to help you ovulate, including metformin, a medicine frequently used to manage type 2 diabetes. Metformin can decrease insulin resistance and it may restart ovulation.

If you don’t want to become pregnant, your doctor might prescribe birth control pills, or a patch or vaginal ring that contain estrogen and progestin help to decrease androgen production which, in turn, can prevent or control excess hair growth and acne. Birth control that contains progestin also helps to lower the risk of endometrial cancer.

Other medications, such as spironolactone or eflornithine can help manage acne or excesss hair growth.

Lifestyle changes are a big — and important — part of managing PCOS. Here’s what can help:

  • Eating foods that can help fight inflammation and keep blood sugars steady, including vegetables, fruit, unrefined grains, fatty fish, nuts, seeds, and avocados.
  • Spacing out carbohydrate foods evenly throughout the day.
  • Aiming for about one-quarter of your plate to be filled with a carb food.
  • Being active most days of the week, for a total of at least 150 minutes each week.
  • Getting enough sleep.
  • Managing stress.

These steps can help with weight loss (weight loss helps to rebalance hormones and decrease insulin resistance), reduce inflammation, and lower your risk of complications related to PCOS, such as type 2 diabetes, heart disease, and high blood pressure.

A registered dietitian can help you develop an eating plan that works for you. And for more information about lifestyle measures that can help, check out Hillary Wright’s book, “The PCOS Diet Plan: A Natural Approach to Health for Women with Polycystic Ovary Syndrome.”

Be sure to see your doctor if your periods are irregular, if you’re having trouble getting pregnant, or if you have excess acne or hair growth. If you’re diagnosed with PCOS, ask your doctor about getting tested for type 2 diabetes and steps to take to help manage this condition if you have it. The lifestyle changes that you make for PCOS will also help you manage diabetes, and decrease the risk of other health problems, too.

Want to learn more about diabetes and women’s health? Read “Diabetes and Your Period” and “Pregnancy and Type 1 Diabetes.”

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES on social media

A Registered Dietitian and Certified Diabetes Educator at Good Measures, LLC, where she is a CDE manager for a virtual diabetes program. Campbell is the author of Staying Healthy with Diabetes: Nutrition & Meal Planning, a co-author of 16 Myths of a Diabetic Diet, and has written for  publications including Diabetes Self-Management, Diabetes Spectrum, Clinical Diabetes, the Diabetes Research & Wellness Foundation’s newsletter, DiabeticConnect.com, and CDiabetes.com

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