Insulin Resistance and PCOS: How to Manage Your Symptoms
November is National Diabetes Month, and RMA of CT is focusing today on how our fertility is affected by insulin resistance in women with PCOS. There is an important connection between the two. If you are a woman dealing with PCOS and attempting pregnancy, it’s important to be aware of the following information.
What is PCOS?
Polycystic ovarian syndrome (PCOS) is the most common endocrine condition in young women representing about 10-15% of the population (and maybe even more). PCOS can be characterized by ovulatory dysfunction (irregular cycles), elevated androgen levels (the “male” hormones), cardio-metabolic dysfunction (elevated cholesterol panel), insulin resistance, and possible weight gain. PCOS patients usually have at least two of the above symptoms but may not have all of them.
What is insulin resistance, and why is it bad for you?
Women who have PCOS are often challenged with insulin resistance. Insulin is a hormone manufactured in the pancreas. It is secreted in response to sugar in the blood stream after eating a meal. Insulin helps to move the blood sugar from the bloodstream into cells to use as energy. When the cells do not respond to the insulin hormone, they are considered “resistant.” The body keeps trying to get a response by having the pancreas send out more and more insulin. Think about it this way: You show up to a friend’s house and knock on the door. No answer. You knock again. Still no answer. So you knock louder and harder. Nothing. It turns out that your friend is actually inside but listening to music through their headphones. She can’t hear you at all. In this case, you are the insulin, trying to send messages, and your friend is the cell, not responding.
At some point, the body becomes desensitized to insulin and loses the ability to regulate blood sugar. Elevated sugars in the blood stream can cause damage to the nerves, blood vessels, and organs. It can also lead to diabetes and other serious conditions.
Insulin can increase androgen (testosterone, the male hormone) production by the ovaries. This can cause irregular cycles which means irregular ovulation or possibly no ovulation at all, making pregnancy difficult.
Researchers say that elevated insulin levels may be toxic to early placental cells. They know that insulin resistance is associated with miscarriage.
Insulin resistance may also lead to gestational diabetes which is the most common pregnancy complication in all women. Women with PCOS have a three times higher risk of gestational diabetes than the general public. Having gestational diabetes can be harmful to your unborn child and increases his or her chance of being overweight and developing insulin resistance.
What Can You do to Optimize Pre-Conception Health if You Have PCOS?
There are three treatment approaches for optimizing your health:
- Regular exercise
- Optimal Nutrition
- Medication if needed
Exercise: A combination of weight bearing exercise and aerobic exercise is optimal and an integral part of your health management with PCOS. Consistent exercise will help with improved insulin levels and better glucose control. In addition, it supports weight loss, lowers androgen levels, improves mood, and may help to regulate ovulation. If you’re overweight, a 5-10% reduction in weight may lead to regular ovulation. Walking at a brisk pace is an excellent overall exercise that can be done before, during, and after pregnancy.
Nutrition: Following a healthy and balanced meal plan is very important. You may want to meet with a nutritionist to review your current diet and tweak it for optimal pre-conception nutrition. Basically, your food plan should include lots of vegetables, whole grains (complex carbs), fruits, beans, lean meats, fish (not too much swordfish or tuna), and some healthy fats such as olive oil and nuts. Avoid processed foods and buy organic as much as you can. Stay hydrated – carry a water bottle around with you.
Check out this helpful guide on how to handle the salad bar in the most nutrient friendly way!
Medications: Medications may be used during your pre-conception phase to lower insulin levels if you have demonstrated insulin resistance and/or some of the PCOS symptoms. There are insulin sensitizing powders and other medications like metformin which your provider may prescribe for you. You may be asked to undergo a two-hour oral glucose and insulin tolerance test to determine your level of insulin resistance and if these medications might help you. If you have diabetes, your endocrinologist may prescribe insulin.
Other lifestyle changes include getting enough sleep and reducing stress levels can majorly help you overcome your PCOS symptoms during pre-conception (and other times, too!). At RMA of CT, we offer counseling, fertile yoga, and acupuncture to optimize pre-conception health. You can also practice meditation or use a sleep app on your phone to help you fall and stay asleep.
What can you do once you are PREGNANT to optimize health?
My biggest piece of advice? Keep up the good work!
Continue to exercise during pregnancy. Daily exercise will only help to optimize insulin levels, but it will keep weight under control and make you feel great. It’s ok to go back to exercising as you did prior to pregnancy with approval from your doctor.
Continue to eat well balanced meals and drink a lot of water. People used to say, “eat up - you are now eating for two.” That’s not actually the case. You do not need to double your intake of food. See a nutritionist for a good meal plan. Your growing baby is exposed to whatever you put into your body so be careful and only put in the most nutritious food you can.
Take any medication prescribed to you as directed. If you are on metformin, don’t take it sporadically, take it on schedule. If you are having trouble or side effects from the medication, speak with your nurse or doctor.
At some point in your pregnancy, your doctor will order a two-hour oral glucose tolerance test to see how your sugar levels are doing. This is the test that signifies if you have developed gestational diabetes or not. Your best chance at fighting gestational diabetes is to practice the previously mentioned healthy lifestyle habits.
At the end of the day, do the best you can, and you will be fine. Enjoy this pre-conception time and your pregnancy! It’s a wonderful time in your life, and remember: you always have a fertility and wellness team on your side to help you no matter what.
Trying to conceive? Here are some ways to improve your chances.
About Diana D’Amelio
As RMACT's resident Physician Assistant, Diana D’Amelio, RPA-C, serves multiple functions at the Norwalk, Danbury, Trumbull and Stamford offices of Reproductive Medicine Associates of Connecticut. As a clinician, she sees patients and performs physicals and procedures such as endometrial biopsies, ultrasounds, hysterosalpingograms and saline sonograms. In addition to reproductive medicine patients, she sees many of the PCOS adolescent population. Diana often does morning monitoring for our patients and evaluates oocyte donors. Diana received her undergraduate degree in biology from Cornell University and completed the Surgeon’s Assistant Program at Cornell University Medical College. She has practiced in the field of infertility since 1993.