PCOS and Insulin Resistance

December 4, 2007 at 6:39 pm Leave a comment

In the 1980s, research on the role of insulin resistance in the development of PCOS became widely known in the fertility treatment community. It appears that insulin resistance probably contributes to the development of PCOS in most women. In some of these women, insulin resistance is related to obesity and genetic factors, both of which are also linked to PCOS.

If you are suffering from PCOS, you may be experiencing difficulties with your fertility. This is because women with PCOS have difficulty maintaining ovulation due to imbalanced hormone levels in their bloodstream. This can make pregnancy extremely difficult to achieve.

However, recent research on PCOS has discovered insulin resistance may actually be triggering PCOS in a large percentage of sufferers. It is hoped that by treating this insulin resistance, fertility can be restored in some PCOS patients. This line of thinking opens up the possibility that PCOS infertility can be treated with insulin sensitizer therapy.

What Is Insulin Resistance?

Insulin resistance occurs when your body is unable to use insulin properly. Insulin is a hormone that helps us to regulate our blood sugar (blood glucose). Insulin helps to transfer sugars from our blood stream to our tissues and cells. It is necessary that your body has the right amount of insulin in order to maintain appropriate blood glucose levels. Some people become resistant to the insulin their body makes. This can trigger your body to develop high levels of insulin, leading to a condition called hyperinsulinemia. This can be very dangerous as it can lead to further health complications.

Insulin resistance is very common in the United States, affecting as many as 1/3 of American men and women. High insulin levels may have harmful effects directly on the function of the ovaries, a symptom of PCOS.

What are the Symptoms of Insulin Resistance?

Insulin resistance typically causes no symptoms in sufferers. If severe, you may begin to notice some of the following symptoms:

  • acne
  • weight gain, especially around the mid-section
  • high blood pressure
  • carbohydrate and sugar cravings
  • dark patches on the skin, particularly on the back of the neck, knees, ankles, elbows, under the breasts, and in the groin area. (Acanthosis Nigricans)

Research studies in the past 20 years have suggested a link between PCOS and insulin resistance. It appears that a large number of women with PCOS have insulin resistance problems. In fact, studies show that up to 30% of women with PCOS have measurable insulin resistance. Because of this research, it is now theorized that perhaps this condition is the root cause of PCOS.

How Does Insulin Resistance Trigger PCOS?

When your body becomes resistant to insulin your pancreas tries to compensate by producing even more insulin. Eventually, your body will produce too much insulin, and this triggers the production of excess androgens.

Androgens, like testosterone, are “male” hormones, which in excess (especially within the ovary) interfere with ovulation, eproduction, and cause a number of PCOS symptoms.

Complications of Insulin Resistance

If you are suffering from PCOS it is a good idea to ask your health care provider to test you for insulin resistance. The most common way to do this is with a glucose challenge test (GTT).

If left untreated, insulin resistance can lead to Type II diabetes, which can cause nerve damage, vision loss, kidney damage, and heart disease.

Some clinicians will use the presence of acanthosis nigricans as the sign that insulin levels are rising, and institute therapy accordingly.

When Is Insulin Sensitizer Therapy Recommended?

Insulin sensitizer drug therapy is a relatively new introduction to the treatment lineup for PCOS, and, it has become very well-known despite its relatively short clinical experience.

Insulin sensitizer therapy works by allowing the body to respond more normally to insulin secretion. This prevents the pancreas from producing too much insulin, and helps to restore hormonal balance. The three most common insulin sensitizers include ACTOS, Avandia and Glucophage (metformin). Metformin is usually the first-line drug in this strategy due to its lower cost and generally beneficial effects on overall weight. ACTOS and Avandia frequently cause a water weight gain of at least five to ten pounds and can cause annoying ankle swelling.

Insulin sensitizer therapy is not meant for all women suffering from PCOS. If you do not have a problem with insulin resistance or if you only have a mild problem, insulin sensitizer therapy probably will not benefit you. Insulin sensitizer therapy is best suited for those women with PCOS proven to be related to insulin resistance.

Insulin Senstizer Therapy is Not the Only Option

Dietary modifications may improve insulin sensitivity as well as pharmaceutical intervention. In later posts I’ll detail various trials of dietary interventions which found improvements when followed by women with PCOS or insulin resistance.

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