Diabetes and PCOS

Wondering what PCOS is and why we’re talking about it in a magazine for people with diabetes? DL dietitian and diabetes educator Dr Kate Marsh explains

It affects about 15 per cent of Australian women of reproductive age and was once considered a fertility issue, but we now know there is more to polycystic ovary syndrome (PCOS) than just difficulty falling pregnant.

Symptoms usually start during puberty, or in the early to mid-twenties, but they can occur at any age, and PCOS is the most common endocrine (hormonal) disorder in women. It is estimated that between 12 and 18 per cent of Australian women of reproductive age are affected, and up to 21 per cent in high-risk groups such as Indigenous women.

So why is there more to PCOS than just fertility issues?

The majority of women with PCOS have insulin resistance underlying their condition – the same problem that occurs in type 2 diabetes. This means women with PCOS are at much higher risk of developing type 2 diabetes. In fact, a 2010 review found that after taking weight into account, women with PCOS had a four-fold increased risk of type 2 diabetes and a 2.5-fold risk of pre-diabetes compared with women without the condition.

A more recent study found that women with PCOS were almost nine times more likely

to develop type 2, and twice as likely to develop gestational diabetes, as women without.

This relationship also means that many women with type 2 diabetes may have PCOS. And if you’re a male with type 2, this is still important as your sisters, daughters and granddaughters could have PCOS or be at risk of developing it.

What causes PCOS?

Exactly why PCOS develops remains unknown, but we do know that there is a genetic component – and a few different causes. But, as discussed earlier, for most women, PCOS is linked with insulin resistance.

Insulin resistance is an insensitivity of the body to insulin. When you have insulin resistance, your insulin doesn’t work effectively, so the body needs to produce increasing amounts of insulin to keep the blood glucose levels under control. In women, high levels of insulin can cause the ovaries to produce more male hormones, which disrupts the normal ovulation cycle and causes many PCOS symptoms.

The good news is that by improving insulin resistance, many symptoms are resolved, or at least improved, and longterm health risks, including the risk of diabetes, can be reduced.

What can I do if I have PCOS?

Management of PCOS has traditionally focused on treating individual symptoms such as acne, infertility, excess hair or irregular periods. It’s now known, however, that lifestyle changes focused on improving insulin resistance can significantly improve all, or most, of the symptoms associated with PCOS.

In fact, programs combining diet, exercise and modest weight reduction (about 5-10 per cent of weight) have been shown to improve symptoms and restore ovulation in women with PCOS, as well as reducing metabolic risk factors (such as blood glucose and insulin levels, and blood fats).

Women who are overweight should aim for modest weight loss, and all women with PCOS should make efforts to prevent weight gain, as carrying extra kilos worsens insulin resistance and the symptoms of PCOS.

While more research is needed into the optimal diet for women with PCOS, it’s currently recommended that they follow general healthy eating recommendations, similar to those with type 2 diabetes. Combining a healthy eating plan with regular exercise is also important and women with PCOS should aim to include at least 30-60 minutes of activity on most days.

Medication may also be needed, but is only effective in

tandem with lifestyle changes. Metformin, commonly used by people with type 2 diabetes, is now often used by women with PCOS and has been shown to have numerous benefits. The oral contraceptive pill, fertility drugs, and other diabetes medications may also be used, depending on treatment goals.

If you haven’t been diagnosed with PCOS but suspect you have it, start by seeing your GP for further investigation. They may refer you to an endocrinologist, reproductive endocrinologist or a gynaecologist. If you have PCOS and need help with your diet, an Accredited Practising Dietitian (APD) can help to develop a personal eating plan.

Seek help today to work on improving your symptoms as well as reducing potential long-term health risks. To find an APD, visit daa.asn.au.

Combining a healthy eating plan with regular exercise is also important