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 ......
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