Insulin Resistance in PCOS

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 heighten PCOS symptoms.

What Is Insulin Resistance?

The hormone insulin 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.

Possible Causes of Syndrome X

Insulin resistance syndrome is thought to be caused by several factors:

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

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 insulin resistance.

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".

Syndrome X has been associated with these disorders:

  • Diabetes
  • Heart disease
  • High blood pressure
  • Hyperglycemia (high blood sugar)
  • Hyperlipidemia (high triglycerides and high cholesterol)
  • Polycystic ovary syndrome
  • Obesity.

Syndrome X Symptoms

Some insulin resistance symptoms are:

Suggestive Laboratory Markers for Insulin Resistance on a Typical Blood Test

  • Depressed HDL cholesterol
  • Elevated triglycerides
  • Elevated uric acid levels
  • Glucose above 115
  • Elevated glycohemoglobin A1C
  • Elevated liver enzymes (sometimes)
  • Low plasma magnesium levels.

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