There has always been a link between Polycystic Ovarian Syndrome (PCOS) and increased levels of insulin (or what is called insulin resistance, a condition that makes it harder for the body to handle blood sugar). But, now, more and more evidence have begun showing a strong association between the two, which spells bad news for PCOS sufferers--insulin resistance can lead to diabetes.
Ob-gyn and reproductive endocrinologist Eileen Manalo, M.D., of St. Luke’s Center for Advanced Reproductive Medicine and Infertility believes insulin resistance can be the “root cause” of PCOS. “When the insulin levels go up, insulin resistance happens and causes increased levels of the male sex hormone androgen. That can result in non-ovulation (the eggs don’t form) or poor egg quality, which in turn can cause infertility and miscarriage.”
There’s also evidence linking PCOS to metabolic syndrome, a host of conditions like “excess body fat around the waist, a blood sugar of 110 mg, increased blood pressure, and rising cholesterol.” If left unchecked, PCOS won’t just be a contributing factor to diabetes but to hypertension, stroke and heart disease. Don’t discount endometrial, breast and ovarian cancer as well although Dr. Manalo emphasizes the link to PCOS isn’t clear yet. “But there is evidence.”
The good news is PCOS is treatable especially if you get diagnosed early, which can be the tricky part. The symptoms are easy to dismiss as “normal” when one is a teenager. The excess body hair and acne are common physical changes when you're entering puberty. Dr. Manalo pays attention to hair that grows on the upper lip, chin, sideburns, chest, upper and lower abdomen, inner thighs, and the upper arms. She adds, “As Asians, we are not as hairy as other people so it can manifest as a few hair strands on the nipple.”
You have PCOS if you meet two out of the following criteria, according to Dr. Manalo
You don’t ovulate on a regular basis so you have intermittent or absent menstruation. For teens, Dr. Manalo says PCOS is often confirmed when her period has been irregular for two years apart from the above criteria.
There are increased levels of androgen that manifest as acne and excessive hair (hirsutism).
You have follicular cysts, measuring at least 9mm in diameter, on one or both your ovaries.
In Dr. Manalo’s experience, 95% of those with PCOS will respond to fertility drugs like clomid and letrozole. Diabetes drug metformin is often part of the treatment, and it helps regulate the amount of glucose in the blood. This drug counts weight loss as a side effect, which is good news for those who are overweight.
Another thing to keep in mind is PCOS has a genetic predisposition. If PCOS runs in the family, whether in the father or mother’s side, you can have it. Dr. Manalo also firmly believes if your family has a history of diabetes or obesity (60% of PCOS women are obese), then you are a candidate for PCOS as well.
Exercise is the biggest favor you can do for yourself. Because PCOS is tied to insulin resistance, weight control and physical activity are necessary. “It’s what I always advocate. There are many patients who get pregnant easily or their periods become regular after weight loss.”
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Dr. Manalo says PCOS is the number one cause of hormonal imbalance. It’s the first thing doctors check when you go to them for missed periods. But, remember, you can have PCOS even if your periods happen like clockwork. Most women don't fnd out about PCOS until they are struggling to get pregnant. So make the ob-gyn appointment a gift to your health even if you think nothing’s wrong.