Treating PCOS Symptoms – Diabetes and Heart Disease
Blood Sugar Control
PCOS is caused by an inborn insulin resistance. Because of insulin resistance patients often have elevated blood sugars. If blood sugars are elevated high enough for prolonged periods, overt diabetes can occur. The patient with PCOS, because of elevated insulin and androgen levels, is in an anabolic state predisposing to excessive weight gain. With weight gain patients develop another form of insulin resistance that is associated with increased adipose tissue. This peripheral insulin resistance on top of the inborn form of insulin resistance can over time result in pancreas “burnout” and overt diabetes. Prevention of diabetes therefore involves lowering insulin levels, this can be done by medications, weight loss and following a “PCOS diet”. Metformin is the most commonly used medication, unfortunately it can be associated with significant GI upset – some patients will not be able to tolerate it. When metformin is used it should be used in low doses gradually titrating up to a therapeutic dose, typically between 1500 and 2000 mg a day. Following a strict PCOS diet will also prevent large spikes in insulin secretion. PCOS patients are recommended to get in 3-4 episodes of brisk aerobic activity weekly to help with weight loss.
PCOS patients, by virtue of their hyperandrogenemia, have significant dyslipidemias. Elevated cholesterol particularly LDL cholesterol can lead to heart disease. Androgen suppression with the birth control pill and/or metformin can be very helpful in diminishing androgen levels and therefore cholesterol levels. Regular aerobic exercise has been shown to be advantageous in lowering bad cholesterol. When these measures are not adequate statin drugs which are very effective in lowering cholesterol may be indicated.