PCOS and insulin resistance – the link

Dr Carmen James educates us on the often heart-breaking mutually destructive relationship between insulin resistance and polycystic ovary syndrome (PCOS)¹.

Understanding insulin resistance

Prediabetes is a condition which occurs when your blood glucose levels are higher than normal but not high enough to be diagnosed with actual diabetes.

Prediabetes usually occurs in people who already have some insulin resistance³. Cells in your body use glucose for energy. Glucose in your body is transported into your cells with the help of the hormone insulin.

Insulin resistance is when cells in your muscles, fat, and liver don’t respond well to insulin and can’t easily take up glucose from your blood³. In response, your pancreas releases more insulin and as a result, both insulin and glucose begin to accumulate in the bloodstream¹.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a common reproductive disorder⁴ that affects as many as 15% of the female population⁵. It is defined as a hormonal disorder common among women of reproductive age⁶.According to statistics, 60-80% of women with PCOS suffer from insulin resistance⁴.

Mutually destructive relationship 

While many of us might know insulin resistance may be a precursor to diabetes^{1, 3} and that excess weight and lack of physical activity could be at fault³, how many of us are aware of the relationship between insulin resistance and PCOS?

The relationship between insulin resistance and PCOS can be described as mutually destructive in that PCOS worsens insulin resistance and vice versa¹.

Not only are high insulin levels a feature of PCOS, they also fuel the disease. The reason for this is because insulin accumulation reduces ovulation and promotes the production of androgens or male hormones. This results in symptoms, such as a male pattern of hair growth (hirsutism), acne and, in some cases, is associated with difficulties with fertility¹.

In fact, 60% of women with PCOS suffer from hair loss, acne and unwanted hair growth and 20% have infertility problems^4.

Alarmingly, more than 50% of women with PCOS will develop diabetes or pre-diabetes before the age of 40⁷.

With so many women affected by PCOS or insulin resistance, or indeed both⁴, the effect on fertility can be heart-breaking.

How does having insulin resistance affect fertility? 

Ovulation occurs during a normal menstrual cycle where an egg is released from the ovary and passes through the fallopian tubes and into the uterus. If the egg is not fertilised, the egg, together with the uterine lining, will be shed during menstruation¹.

Because an accumulation of insulin in the bloodstream elevates androgen levels, the resulting hormone imbalance will negatively affect ovulation. When women do not ovulate, they may menstruate less frequently, have irregular cycles and, in some instances, they may not menstruate at all. If an egg is not released into the uterus, conception will not occur.

PCOS is the most common cause of irregular menstruation that leads to infertility⁴.

While it is more likely for overweight and obese women to experience insulin resistance¹ and PCOS⁶, women of a normal weight can be affected too. It is important to remember that weight alone is not an absolute representation of health.

Address the underlying root condition

It is recommended that women with PCOS and/or insulin resistance address the underlying root cause drivers of their condition. While we can’t control our genes, we can aim to live a healthy lifestyle to reduce the negative effects of both PCOS and insulin resistance.

Adopt a healthy diet, rich in plant-based foods and low in refined carbohydrates; enjoy regular physical exercise; add supplements, including myo-inositol; curcumin; powerful antioxidants, such as Alpha-lipoic acid; folate and berberine; manage stress levels and get good quality sleep. These measures will reduce inflammation, improve insulin sensitivity and begin to bring balance to the hormones to support ovulation¹.

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