The term “diabetes of the ovaries” is not a formal medical diagnosis but a common way to describe Polycystic Ovary Syndrome (PCOS). This informal description arises from PCOS’s strong connection with insulin resistance, a metabolic condition that can lead to elevated blood sugar levels.
The Link Between Ovaries, Hormones, and Insulin Resistance
Polycystic Ovary Syndrome (PCOS) is a complex hormonal disorder affecting women of reproductive age, characterized by ovarian dysfunction and elevated androgen levels. Ovarian dysfunction often presents as irregular menstrual periods or their absence, and the presence of numerous small follicles on the ovaries, visible on ultrasound. Elevated androgen levels, sometimes referred to as male hormones, are a consistent feature.
A central feature of PCOS is insulin resistance, where the body’s cells do not respond effectively to insulin, a hormone that helps regulate blood sugar. This prompts the pancreas to produce more insulin, leading to higher levels in the bloodstream. This compensatory hyperinsulinemia can directly stimulate the ovaries to produce excessive amounts of androgens. The increased androgen production, in turn, can disrupt the menstrual cycle by interfering with the development and release of eggs from the ovaries, a process known as anovulation.
Furthermore, elevated insulin levels can reduce the production of sex hormone-binding globulin (SHBG) by the liver, a protein that binds to androgens in the blood. A decrease in SHBG leads to an increase in “free” androgens, intensifying their effects on the body. This interplay between insulin resistance, hyperinsulinemia, and androgen excess contributes to the various manifestations of PCOS. Insulin resistance is prevalent in both obese and lean women with PCOS.
Recognizing and Diagnosing PCOS
Individuals with PCOS often experience various signs and symptoms. Common symptoms include irregular or absent menstrual periods, excessive hair growth (hirsutism), acne, thinning hair or hair loss from the scalp, and difficulty conceiving.
The diagnostic process for PCOS typically involves a multi-faceted approach. A healthcare provider will review a person’s symptoms and medical history, followed by a physical examination. Blood tests are usually conducted to measure hormone levels, such as androgens, and to assess glucose and insulin levels. These tests help to exclude other conditions that might present with similar symptoms, such as thyroid dysfunction or elevated prolactin levels.
An ultrasound of the ovaries may also be performed to check for polycystic ovarian morphology, defined as the presence of 12 or more follicles measuring 2-9 mm in diameter or an ovarian volume greater than 10 mL in at least one ovary. The Rotterdam criteria are widely accepted for diagnosing PCOS, requiring the presence of at least two out of three features: oligo-anovulation (irregular or absent ovulation), hyperandrogenism (clinical or biochemical evidence of excess androgens), and polycystic ovaries on ultrasound, after excluding other potential causes.
Managing PCOS and Its Associated Health Risks
Managing PCOS involves a personalized approach, tailored to an individual’s specific symptoms and health goals. Lifestyle interventions form the foundation of management, with dietary changes and regular physical activity being paramount. Even a modest weight reduction, such as losing 5% of body weight, can significantly improve PCOS symptoms and overall health, including potentially restoring ovulation. Adopting a balanced diet rich in fruits, vegetables, whole grains, lean meats, and fish, alongside at least 150 minutes of moderate exercise per week, can help manage insulin levels and improve the condition.
Medical treatments are often used in conjunction with lifestyle changes to address specific symptoms. Oral contraceptives are frequently prescribed to regulate menstrual cycles and reduce androgen levels, which can help manage excessive hair growth and acne. For those with insulin resistance, medications like metformin, typically used for type 2 diabetes, can be prescribed to improve insulin sensitivity and lower blood sugar levels, which may also reduce androgen production and improve menstrual regularity.
Managing PCOS effectively also helps mitigate several long-term health risks. Individuals with PCOS have an increased risk of developing type 2 diabetes, cardiovascular disease (including high blood pressure and high cholesterol), and endometrial cancer. Regular periods, often achieved through hormonal treatments, help reduce the risk of endometrial cancer. For individuals facing fertility challenges, treatments such as clomiphene or letrozole are commonly used to induce ovulation, and in some cases, assisted reproductive technologies like in vitro fertilization (IVF) may be considered.