Women with PCOS are at risk of developing metabolic syndrome (a pre-cursor to diabetes) and have decreased insulin sensitivity, known as insulin resistance, compared with women of similar body weight with normal ovaries. Evidence suggests that insulin resistance is the likely link between PCOS and the metabolic syndrome, [1a], [b], [c], [d], although insulin sensitivity is not always found with PCOS, particularly with non-obese women. Family history seems to be an important factor, as women with PCOS and a positive family history of type 2 diabetes seem to have a higher risk of abnormal insulin sensitivity and secretion.
Insulin resistance worsens with increasing obesity, which is a major feature in women with PCOS. High levels of insulin appear to stimulate and increase blood levels of androgens (male hormones) in PCOS and suppress a protein called sex hormone binding globulin (SHBG), a protein that binds to sex hormones and keeps the levels available in the blood at optimum levels. The use of insulin-sensitising drugs (see below) has been shown to decrease blood levels of insulin in both obese and non-obese women with PCOS, and to simultaneously reduce circulating androgens and to improve ovulation.  PCOS can cause the ovaries to stop ovulating, which means that the normal cyclic production of estrogen followed by progesterone either ceases or becomes dysfunctional. Insulin stimulates the ovaries to produce predominantly male hormones, which, in combination with higher insulin and glucose levels, increase weight gain around the waist – a body type that is a risk factor for breast cancer.
Signs that the body is being exposed to higher levels of the male hormones include acne, loss of head hair and an increase in body hair. Lowering insulin levels is crucial for not only treating PCOS but also resolving most other hormonal imbalances, including those leading to breast cancer. Depression or mood swings are also common in women with PCOS and it is also associated with insulin resistance, hormone imbalances and being overweight. Infertility and miscarriages, common consequences of PCOS, also can be very stressful and depressing. Too much stress may aggravate many aspects of the syndrome, including insulin resistance.
There are a number of blood tests that will probably have been performed by your doctor if you have, or are suspected of having, PCOS. An ultrasound may also be performed to confirm the diagnosis. Blood test results that are generally found in women with PCOS include:
• HIGH androgen levels (male hormones, such as testosterone), luteinising hormone (LH), fasting insulin, prolactin, estradiol and estrone, tryglycerides, total and LDL (‘bad’) cholesterol.
• LOW levels of SHBG, which are decreased by high levels of insulin, as explained above.
How is PCOS Treated?
There are many medications to control the symptoms of PCOS. Doctors most commonly prescribe birth control pills for this purpose. Birth control pills regulate menstruation, reduce androgen levels and help to clear acne. Your doctor may also prescribe an insulin-sensitising medication, such as Metformin (see below). It is important to discuss the risks and benefits of these medications to find out which, if any, is right for you. Metformin is an insulin-sensitising medication, which may be prescribed for PCOS, [5a], [b], [c], [d] although some experts believe this should be prescribed with caution  and not ‘as a replacement for increased exercise and improved diet’. 
A meta-analysis of 13 randomised, controlled trials including 543 women and published in the British Medical Journal in 2003, found that Metformin has an effect in reducing fasting insulin concentrations, blood pressure, and LDL (‘bad’) cholesterol. However, it was also associated with some unpleasant side-effects, including nausea, vomiting and gastrointestinal disturbance, which limited participation levels in some trials. One of the outcomes measured was the ‘overall ovulation rate’ achieved by metformin alone, or metformin combined with another drug (clomifene). Interestingly, the overall rate of 57% was lower than ovulation rate achieved with lifestyle improvements, that included increased exercise and weight loss.  Metformin also interferes with the action of vitamin B12 and may raise your homocysteine level. Make sure you are supplementing vitamin B12 if you are on this drug.
Eating a low-GL diet and maintaining a healthy weight can improve insulin sensitivity and help lessen the symptoms of PCOS. Dairy products also promote high insulin levels so are best avoided. The essential mineral chromium is required for normal insulin function and supplementing 200 to 600mcg a day helps reverse insulin resistance. Follow my Low-GL diet, which will not only address symptoms of PCOS but will also help to minimise the chance of associated conditions, as outlined above.
Controlling your blood sugar levels is key to managing this condition. The net result of stress, or a diet too high in sugar and refined carbohydrates, is an inability to keep ......
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