PCOS and Insulin Resistance

I have polycystic ovary syndrome (PCOS) and was told that insulin resistance may be a large component of my disorder. How can this cause me not to ovulate?

Question:

Burghen and colleagues first observed a correlation between serum insulin and testosterone levels in women with polycystic ovary syndrome (Burghen GA, Givens JR, Kitabuchi AE. Correlation of hyperandrigenism with hyperinsulinism in polycystic ovarian disease. J Clin Endocrinol Metab 1980;50:113-6). This observation resulted in scores of investigations which collectively suggest that hyperinsulinemia produces hyperandrogenism (elevated male hormone levels) by stimulating ovarian androgen production and/or by independently reducing sex hormone binding globulin levels (carrier protein for testosterone). These mechanisms are not mutually exclusive.

It also appears that some women have a genetic predisposition in their ovaries to be more susceptible or sensitive to insulin and respond with ovarian androgen production. Elevated insulin levels may also affect the secretion of pituitary gonadotropins (FSH and LH) resulting in more ovarian androgen production. Thus, insulin resistance and elevated ovarian androgens appears to create an ovarian environment which cannot support the orderly development of an ovarian follicle, resulting in anovulation.

Recent clinical investigations have demonstrated that lowering insulin levels results in reduced androgen levels and in some cases allows ovulation to occur. While the significance of the insulin lowering agents (in potentially assisting in developing ovulation in women with PCOS) is recognized, the true significance of this finding may be in the long term consequences of reduced insulin levels in PCOS women.

It is possible that reduced insulin levels may prove to reduce the medical risks of glucose intolerance (diabetes), dyslipidemia (bad lipid parameters in the blood leading to clogging of the arteries), hypertension (high blood pressure), atherosclerosis (clogging of the arteries), obesity and the cosmetic issues of hirsutism (male pattern hair growth), and acne.

A discussion with your reproductive endocrinologist will help to determine if an insulin lowering agent is indicated in your case of PCOS.

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