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Polycystic ovary syndrome and diabetes risk: metabolic links with PCOS

Polycystic ovary syndrome, or PCOS, is the most common hormonal condition in women of reproductive age, affecting between five and 10 per cent of women.

PCOS is the most frequent cause of irregular periods, and one of the condition’s defining features – as the name suggests – is multiple cysts on the ovaries. However, PCOS is more than a reproductive condition. It’s a metabolic condition that is linked to health issues such as insulin resistance, diabetes and sleep apnea.

“Insulin resistance is what underlies PCOS,” says endocrinologist Dr. Sheila Laredo, chief of staff at Women’s College Hospital. “Not all women have evidence of insulin resistance with PCOS, but most do. Women with PCOS have a four to five times increased risk of developing diabetes. They have an increased risk of high blood pressure, abnormal cholesterol, fatty liver, sleep apnea, and probably increased risk of cardiovascular disease.”

Because of these increased risks, blood sugar testing may be recommended for even young women with PCOS.

“In women under 45 with PCOS, the risk of having either prediabetes or diabetes is almost 40 per cent,” Dr. Laredo says. “So we have to screen for diabetes in a very different way than you screen the rest of the population.”

Diagnosing PCOS

To be diagnosed with PCOS, a woman must have at least two of the three key symptoms. In addition, other possible causes that can mimic PCOS must be ruled out. The three key symptoms of PCOS are:

  1. abnormal periods: either absent periods (three to six months with no period), or irregular periods (periods that start more than 35 days apart on average)
  2. evidence of high male hormones: this can be either elevated male hormone levels on tests, or physical symptoms of high male hormones such as acne, loss of hair on the scalp, or male-pattern hair growth on the body or face
  3. polycystic ovaries seen on ultrasound

Risk for PCOS is higher in women with a family history of the condition. Women who have a first-degree relative (a sister, mother or daughter) with PCOS have a 35 to 40 per cent chance of developing the condition, Dr. Laredo says.

“We typically see that there’s also a family history of insulin resistance,” she explains. “Because the insulin resistance doesn’t always come down the maternal side. It can come down the paternal side. So what you’ll see in Dad is maybe a history of diabetes or high blood pressure or cholesterol.”


Treatments for PCOS may address specific symptoms. Because it is a life-long condition, the needs and priorities of women with PCOS change over time.

“There’s no one-size-fits-all treatment,” Dr. Laredo says. “Some women are trying to get pregnant, so we try to give them more regular periods. Some women have major concerns about acne or facial hair that they find really distressing, so we treat that by reducing male hormones. Some women are just trying to prevent diabetes and prevent health complications down the road.”

Sleep apnea is also more common in women with PCOS: studies have found their risk of sleep apnea to be as high as one in six.

“That’s about 30 times higher than the general population,” Dr. Laredo says. Treating sleep apnea can have a profound effect on well-being.

“If you’re not exhausted all the time, it has a big downstream effect,” she explains. “Now you’re actually interested in doing that program at the gym. Now you’re interested in going for walks with your kids. You have the energy to actually cook a healthy meal rather than do takeout.”

Metabolic issues

PCOS treatment often means addressing the underlying metabolic condition.

“The best treatment we have for insulin resistance continues to be lifestyle: diet and exercise,” Dr. Laredo says. “Some of the drugs that we use in PCOS and in diabetes and insulin sensitivity are still not as good as lifestyle in terms of the outcome. So we always talk about lifestyle.”

Lifestyle changes may sound challenging for the many women with PCOS who struggle with weight issues. But Dr. Laredo stresses that the goals for treatment are achievable: losing five to 10 per cent of body weight.

“Five to 10 per cent weight loss in women with PCOS is often enough to improve regularity of periods,” she says, adding that diabetes research has shown that losing a similar amount of weight can prevent diabetes in those prone to it.

“Medically, we’re not looking for the amount of weight loss that women think they need to be successful. Women think they need to lose 30, 50 or even 100 pounds. We’re looking for five to 10 per cent, so in a woman who weighs 200 or 250 pounds, we’re talking about 10, 12, 15 pounds. If you can do that and sustain it, it can have a big impact.”

It’s also important to remember that PCOS does not end at menopause: the metabolic condition continues, and so does the increased risk for diabetes. It’s recommended that menopausal women with PCOS continue to be screened for diabetes more regularly than standard guidelines suggest.

“They should think of themselves as higher risk, and their physicians should think of them as higher risk,” Dr. Laredo says.

This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: Jan. 16, 2015

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