Articles
Polycystic Ovarian Syndrome
What is it?
It is a condition that occurs in 5 to 10% of women of reproductive age.
Some of the features that may be present are:
- Multiple small follicles incorrectly called cysts on the ovary.
- Irregular or only occasional periods that may be heavy when they occur.
- Difficulty in becoming pregnant
- Problems with weight gain particularly around the middle.
- Excess facial and body hair called hirsutism
- Acne
- Higher levels of blood fats including cholesterol and triglycerides
What causes it?
It is not clear but it can be a combination of environmental and genetic. It is felt that part of the gene that regulates insulin secretion may function abnormally. This leads to a condition called insulin resistance. This can affect the way cells handle glucose and in the way ovarian cells respond to the hormone that stimulates testosterone production.
Insulin Resistance
In some people, the body cells do not respond to the insulin. This is called insulin resistance. As the glucose does not move freely into the cell, our blood concentration of glucose increases. When body cells become resistant to insulin, the pancreas over produces insulin to try to compensate. The resulting hyperinsulinaemia is the major factor behind insulin resistance syndrome.
It is thought that around one in four people show signs of insulin resistance.
Testing For Insulin Resistance
Insulin resistance can be determined with a simple fasting blood test.
Current guidelines indicate:
Fasting insulin:
- <10 mU/L normal
- 10-14 mU/L mild to moderate insulin resistance
- >14 mU/L moderate to severe insulin resistance
Insulin levels may also be checked during a Glucose Tolerance Test (GTT). Levels of 100 or more at 1 or 2 hours show severe insulin resistance.
Effects Of Insulin Resistance
Obesity
Obesity is strongly linked with insulin resistance. This is mostly due to insulin’s effect of promoting the production of fat (lipogenesis) and the development of adipose tissue. Alternatively, obesity is also a major factor in the development of insulin resistance.
Cardiovascular Disease
There is an increased risk of cardiovascular disease. This is usually accounted for by obesity, hypertension and changes to the lipid profile. Often the insulin tends to increase blood triglyceride levels and decrease HDL (good cholesterol) levels.
Hormone Imbalance
The hyperinsulinaemia also affects other hormones. In particular there is an increase in androgens. This can result in acne, Polycystic Ovarian Syndrome, infertility and hirsutism.
Diabetes
Finally, there is a greatly increased risk of developing diabetes. The excessive production of insulin by the pancreas to compensate for the insulin resistance can cause the pancreas to fail to cope with the continued production and lead to diabetes.
TREATMENT OF PCOS
DIET TO ACHIEVE WEIGHT LOSS
Diet in combination with exercise can assist with weight loss thus reducing insulin resistance. It is more difficult to lose weight with PCOS so being very careful about fat and total kilojoules is very important. Many women reduce the amount of fat but still eat too many kilojoules in the form of rice, pasta and bread. This excess carbohydrate is then stored as fat. Consume a low fat, low sugar and high fibre diet. Include breads and cereals (preferably wholegrain), fruit and vegetables, lean meat and low fat dairy products. Eat smaller meals more frequently as this will give further satiety and keep insulin levels lower.
Low Glycaemic Index
Consume low glycaemic index foods. These foods result in a slower increase in blood sugar levels over a period of time resulting in a sparing effect on insulin requirements. Choosing low GI foods also spares insulin and keeps the levels lower. Aim to have one low GI food such as milk products, whole grain breads and pulses at each meal.
Omega –3 Fatty Acids
Increase intake of fish and other sources of omega-3 fatty acids. A high intake of omega-3 has been shown to decrease insulin resistance.
EXERCISE
With PCOS it is difficult to achieve fat burning. In order for this to occur, usually 45 minutes of brisk walking, cycling, swimming or any aerobic exercise is necessary. This should be done at least six days a week but preferably seven. Exercise lowers the level of insulin in the blood making it easier to burn the fat.
OTHER FACTORS
Be a non-smoker Look at ways to alleviate stress There may be a need for drug therapy. These medications are typically used to manage blood glucose levels in people with diabetes but are also very effective with insulin resistance and PCOS eg Metformin
Useful web sites
Women’s health information centre- www.rch.unimelb.edu.au
Added to site on : Monday, 16 June 2003