POLYCYSTIC OVARIAN SYNDROME (PCOS) AND INSULIN RESISTANCE.

PCOS

Polycystic ovarian syndrome is an endocrine disorder common among the women of reproductive age. It is not only disorder of ovaries as the name suggests but also the metabolic and hormonal disorder which results in various symptoms like;

• Heavy ,painful and irregular menstrual cycles 

• Unwanted increase in

  body hair (hirsutism)

• Dark skin patches 

• Male pattern baldness

But should typically have at least two of the three primary characteristics of;

1. Androgen excess (can present as increased body hair)

2. Chronic oligo anovulation (can present as absent or irregular menstrual cycles)

3. Presence of polycystic ovaries (1)

The other conditions include;

• Insulin resistance 

• Type 2 diabetes

• Heart disease

• Obesity

INSULIN RESISTANCE

Under normal conditions, insulin increases briefly after eating which stimulates liver and muscles to take up glucose from blood and convert it into energy. That then causes blood sugar to fall and then insulin to fall. With normal insulin sensitivity, both sugar and insulin are normal on a fasting blood glucose level.

With insulin resistance, blood glucose may be normal but insulin is high. It is because body becomes resistance to insulin so a large amount of insulin is produced by pancreatic beta cells but due to insulin resistance body is not able to use the produced insulin.(2)

RELATIONSHIP BETWEEN INSULIN RESISTANCE AND PCOS

Insulin resistance is a key feature of both obese and lean PCOS. It occurs in 70 to 95 % of people with obese PCOS and 30 to 75% of people with lean PCOS. (3, 4)

Insulin resistance is a key contributor to metabolic disturbance and is a driver in the pathogenesis of PCOS. 

In a study of a group of population consisting of 9 PCOS women, 6 obese type 2 diabetic patients and 5 controls whose BMI was a similar to that of PCOS women, the women with PCOS showed significantly elevated insulin responses during OGTT (oral glucose tolerance test) but their blood glucose was comparable with the control. (5)

The statistical association between insulin levels and androgens originally put the focus on possible cause and effect relationship between these factors. As insulin may affect ovarian function ceasing ovulation and causing hyperandrogenism, increased corticosteroid production can contribute to insulin resistance directly or through promoting accumulation of abdominal fat, a typical feature of overweight women with PCOS .(6)

DIAGNOSIS OF INSULIN RESISTANCE IN PCOS

About 50 to 70% of women with PCOS have insulin resistance contributing hyperandrogenism responsible for signs and symptoms of PCOS. Early diagnosis may prevent incidence or severity of diabetes mellitus, dyslipidemia, hypertension and cardiovascular diseases. 

Hyperinsulinemic –euglycemic clamp technique is gold standard for measuring insulin sensitivity, it is too expensive and time consuming. Fasting glucose/insulin ratio or homeostatic model assessment (HOMA) value and oral glucose tolerance test (OGTT) are the easiest assessment of insulin resistance in PCOS patients. (7)

TREATMENT OF INSULIN RESISTANCE IN PCOS

Lifestyle modifications are the first line therapy for all obese women with PCOS. But weight loss is difficult to achieve and maintain in many women with PCOS and is not option for lean women with PCOS. Insulin sensitizing drugs are proving to be a promising and unique therapeutic option for chronic treatment of PCOS. (8)

Oral contraceptives are other officially recommended treatment for PCOS but can interfere with glucose regulation and insulin resistance. Fructose can be used as dietary intervention as high dose fructose from desserts, soft drinks and fruit juice has effect on PCOS. (2)

NUTRITIONAL SUPPLEMENTS FOR INSULIN RESISTANCE AND PCOS

Inositol is an intracellular messenger involved in insulin signaling and can be taken as nutritional supplement. Magnesium works to correct Mg deficiency that is suspected to be contributing in insulin resistance. (2)

Susmita Baral

B.Sc.MLT 4thsemester

REFERENCES

1. https://www.virtahealth.com/blog/pcos-polycystic-ovarian-syndrome

2. https://helloclue.com/articles/cycle-a-z/the-link-between-pcos-and-insulin-resistance

3. Stepto, N.K., et al., Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemichyperinsulaemic clamp. Hum Reprod, 2013. 28(3): p. 777-84.

4. Randeva HS, Tan BK, Weickert MO, Lois K, Nestler JE, Sattar N, Lehnert H. Cardiometabolic aspects of the polycystic ovary syndrome. Endocr Rev. 2012 Oct; 33(5):812-41.

5. KH Park KY Kim, CW Ahn ,YD Song, SK Lim ,HC Lee ,International Journal of Gynecology and Obsterics 74(3), 261-267,2001

6. Jan Holte , Journal of endocrinological investigation 21(9), 589-601,1998

7. Richard S Legro, V Daniel Castracane, Robert P Kauffman ,Obstetrical and gynecological survey 59(2),141-154,2004

8. Susmeeta T Sharma, John E Nestler, Best practice and Research Clinical Endocrinology and Metabolism 20,245-260,2006