Insulin Resistance a Major Cause of PCOS Symptoms

Although estimates vary, about 30%-80% of women with PCOS have insulin resistance.

Hyperinsulinemia (high blood insulin levels) produces hyperandrogenism (excessive levels of male hormones such as testosterone) by stimulating ovarian androgen production and by reducing serum sex-hormone binding globulin (SHBG). This can make PCOS symptoms a lot worse.

What Is Insulin Resistance?

The hormone insulin performs many essential functions in the body but is primarily known for its role in glucose regulation. Under normal circumstances, insulin assures the efficient transfer of glucose from the bloodstream to the body. Insulin also serves as a signal to the liver to begin or discontinue glucose production.

If the level of glucose in the cells is sufficient, insulin levels drop, signaling the liver to slow down glucose production. In contrast, if the cells of the body are not receiving enough glucose, the level of insulin will rise, signaling the liver to produce greater amounts of glucose.

Insulin resistance (also known as Syndrome X) is the inability of insulin to perform its job effectively in the body. In early stages of Syndrome X, the body simply compensates by causing the beta cells of the pancreas to produce more insulin. Ultimately in some women, however, the beta cells may wear out and the body ceases to produce insulin in the amounts needed. The resultant condition is Type II diabetes mellitus.

What Are the  Causes?

Insulin dysfunction is thought to be caused by several factors:

  • Genetic abnormalities of one or more proteins of the insulin action cascade 
  • Fetal malnutrition 
  • Increased fat around the middle.

It's thought that perhaps 50% of people have an inherited propensity for this disorder. You may be in this group if you have a family history of diabetes, cardiovascular disease, hypertension or PCOS. The other 50% who develop insulin resistance probably do so because of unhealthy diet, no exercise, and obesity.

Although obesity is a major risk factor, lean women with PCOS can also have this insulin problem.

Although you can't change your genes, there's plenty you can do to change how they behave. What you eat, whether you exercise, how well you sleep, how you manage stress, and the pollutants you are exposed to will directly influence what your genes do. So to a great extent, the insulin hromone can be controlled by you.

Insulin Resistance and PCOS

As early as 1921, a French study described the presence of diabetes in women with facial hirsutism. PCOS women also show higher levels of possible precursors of diabetes, such as glucose intolerance and lack of insulin sensitivity.

Over the past 20 years, it has been established that hyperinsulinemia is a fundamental disturbance in many women with polycystic ovary syndrome (PCOS). A subgroup of women with this syndrome have 'metabolic PCOS' which can be considered to be a pre-diabetic state. Clinically, this subgroup is most easily identified in obese women with a strong family history of diabetes in whom menstrual disturbance is the predominant feature.

The increased incidence of insulin resistance occurs in all PCOS women, not simply obese women. Most women with polycystic ovary syndrome (PCOS) are obese and are known to be insulin resistant. Obesity per se is a cause of insulin Syndrome X.

A significant degree of insulin resistance exists in non-obese women with PCOS and is significantly related to serum LH and free testosterone levels.

Therefore, measures to decrease this condition may have to be considered earlier to decrease the potential risks of developing diabetes mellitus and coronary artery disease at later ages of life in both overweight and normal weight women who have PCOS.

A major complicating factor for PCOS women is that some types of cells - most commonly muscle and fat - in the body can be insulin resistant, while other types of cells and organs are not. As a result, the pituitary, ovaries, and adrenal glands of an insulin resistant woman will be stimulated by far higher levels of insulin that would be desired, thus causing elevated luteinizing hormone and androgens. This phenomenon is referred to as "selective resistance".

How Do I Know if I Have Insulin Resistance?

You may have this problem if you have three or more of these clinical laboratory markers:

  • High blood pressure chronically over 140/90 (optimal is 120/80). 
  • 15 or more pounds over your ideal weight. 
  • Triglycerides over 160 (optimal is less than 100). 
  • Total cholesterol over 240 (optimal is 180-200). 
  • HDL “good” cholesterol less than 1/4 of total cholesterol. 
  • Fasting glucose over 115 (optimal is less than 100). 
  • Elevated uric acid levels 
  • Glucose (blood sugar) above 115 
  • Elevated glycohemoglobin A1C 
  • Elevated liver enzymes (sometimes) 
  • Low plasma magnesium levels.

Insulin problems are a contributing factor to:

  • Polycystic ovary syndrome 
  • Infertility 
  • Diabetes 
  • High blood pressure 
  • Cardiovascular disease 
  • Inflammatory disorders 
  • Cancer 
  • Other degenerative disorders 
  • Shortened lifespan. 
  • Acne 
  • Apple-shaped obesity 
  • Difficulty with weight loss 
  • Hirsutism 
  • Sugar or carbohydrate cravings.

Insulin resistance is a big problem for women with PCOS because it is "selective". Your muscle and fat cells can be insulin resistant while other types of cells and organs are not. For instance, your pituitary, ovaries and adrenal glands may be over-stimulated by high levels of insulin, thus increasing androgens and luteinizing hormone. This hormonal imbalance may render you infertile, in addition to creating other health problems.

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