PCOS And Diabetes: What Is The Connection?

Polycystic ovary syndrome (PCOS) is a common condition that affects 6% to 12% of women of childbearing age. Besides making it harder to get pregnant, PCOS can increase the risk of developing certain conditions, such as heart disease, high blood pressure, and diabetes.¹

If you have PCOS, monitoring your health closely to catch any associated problems early and start getting appropriate treatment is important.

Let's take a closer look at PCOS and diabetes.

What is PCOS?

Polycystic ovary syndrome is characterized by anovulation or oligo-ovulation (lack of ovulation or irregular/infrequent ovulation), signs of androgen excess like hirsutism, and numerous ovarian cysts.

Contrary to the name, PCOS doesn't necessarily cause cyst formation. Based on the most commonly accepted criteria, the Rotterdam Criteria, multiple follicles without cysts are also diagnostic.²

PCOS is one of the leading causes of infertility. Between 70% and 80% of women with this condition can't get pregnant.³

Common symptoms of PCOS are:

• Disrupted menstrual cycles: You can miss periods or have them come more often than normal (every 21 days or less).

• Excessive hair growth (hirsutism): You may notice excessive hair growth on the face and on other androgen-dependent areas such as the chest, back, and linea alba. Around 60% of women with PCOS have this problem.⁴

• Acne: About 15–25% of women with PCOS can have acne, which is nonspecific.⁵

• Scalp hair loss (alopecia): Some people with PCOS experience male-pattern baldness.

• Darker skin (acanthosis nigricans): Your skin may darken in the neck area, underneath the breasts, and in the groin. However, this is secondary to hyperinsulinemia and is seen more commonly in obese women with PCOS.

Even if you aren't trying to get pregnant, you may still need to get treatment for PCOS. If you are experiencing these symptoms, let your doctor know so they can arrange treatment.

What are the causes of PCOS?

The exact cause of PCOS is yet to be discovered. Some theories include defects in insulin sensitivity or defects intrinsic to ovaries leading to excess androgen production. Furthermore, PCOS seems to be inherited as a common complex disorder.

While researchers are yet to identify the exact gene(s) that may be responsible for PCOS, between 20% and 40% of women with the condition have immediate relatives with the same condition (usually sister or mother). Concordance in twin studies is as high as 70%.⁶ ⁷

How PCOS and diabetes are related

By the time they turn 40, more than 50% of women with PCOS will develop diabetes.⁸

While further research must be done, scientists believe PCOS and insulin resistance are part of a vicious cycle. As insulin resistance exacerbates PCOS by stimulating the ovarian androgen output, this, in turn, may exacerbate insulin resistance.

If left untreated, high levels of insulin can make both PCOS and diabetes worse.

PCOS and gestational diabetes

While getting pregnant with PCOS is challenging, the right treatment can battle infertility. However, PCOS also puts a woman at a higher risk of developing gestational diabetes.

Gestational diabetes is diabetes that develops during pregnancy. Blood sugar levels are typically increased and can lead to complications, such as:

• Premature birth

• Baby born with low blood sugar levels

• Risk of having a large baby

• Risk of the baby developing type 2 diabetes later in life

A doctor can develop an individual course of treatment to minimize the chances of complications.

Treatment for PCOS and diabetes

If you have PCOS and diabetes, your healthcare provider can suggest different types of treatment, including:

Lifestyle changes

Exercise and a healthy diet are essential to managing insulin levels and preventing obesity, both contributing to PCOS. Lifestyle changes are effective for managing PCOS, even more so than some medications. Accordingly, a healthy diet is important.

Ovulation medication

 If you plan to get pregnant, the doctor may prescribe medications that stimulate ovulation. However, these meds have certain side effects that warrant in-depth discussion with your healthcare provider.

Birth control pills

If you don't plan to get pregnant, these pills can help control your menstrual cycle, reduce androgen levels, and decrease PCOS-related acne.

People with PCOS and insulin resistance who haven't developed diabetes yet may start managing their symptoms with changes in diet and activities. However, a doctor may also prescribe diabetes medication.

If you have both PCOS and diabetes, your healthcare provider may prescribe metformin, amongst other medications. This drug can help your body use insulin better and can be used to combat both Type 2 Diabetes Mellitus and oligomenorrhea.

In rare cases, people who have type 2 diabetes may need to use insulin. This happens if other medicines don't reduce blood sugar levels effectively. However, for most people with PCOS and diabetes, diet, exercise, and oral antidiabetics (including Metformin) are usually sufficient to control the symptoms.

Your doctor can also prescribe medication to treat co-occurring conditions like heart disease, mood disorders, hyperlipidemia, or high blood pressure.  

Can you prevent diabetes if you have PCOS?

If you have PCOS, you have a high chance of developing diabetes. While preventing this condition may not always be possible, you can try to keep your insulin resistance in check. Here are some ways you can do this.

• Lose weight: According to the CDC, losing 5–7% of your starting weight can reduce your chances of developing diabetes.⁹

• Daily exercise: A minimum of 30 minutes of moderate-intensity activity can aid in weight loss and overall health.

• Consider metformin: Some studies show that taking metformin can prevent the development of diabetes in the context of PCOS as well. Speak to your doctor about the possibility.¹⁰

If you are getting treatment for PCOS, you are probably already doing everything you need to try and prevent diabetes.

The lowdown

PCOS can increase your risk of developing diabetes. That's why speaking to your doctor about prevention options is imperative. If you already have PCOS and diabetes, treatments for these two conditions can be. You can alleviate the symptoms and lead a normal life with the right approach.

If you think you may have PCOS, contact your doctor to discuss the diagnosis and the available treatment options.

Frequently asked questions

Can you get pregnant with PCOS and diabetes?

Yes. With the right treatment, getting pregnant is possible if you have one or both of these conditions.

What type of diabetes does PCOS cause?

PCOS can increase the risk of type 2 diabetes and gestational diabetes.

Why is insulin high in PCOS?

Women with PCOS do not seem to respond to insulin normally, which is termed insulin resistance. This leads to a compensatory increase in insulin secretion, leading to hyperinsulinemia (high insulin levels). However, the cause of increased insulin resistance and, subsequently, the compensatory hyperinsulinemia in PCOS is yet to be elucidated.