Treatment of PCOS has traditionally focused on managing individual symptoms such as acne, infertility or hirsutism. For women with PCOS and insulin resistance, however, it has been found that treating the insulin resistance can significantly improve all or most of the symptoms associated with this disorder, by reducing androgen and LH levels and restoring ovulation.
Treatment of PCOS and insulin resistance should focus on two areas
1. managing symptoms
2. reducing the risk of long term complications such as diabetes and heart disease
Insulin resistance can be improved with lifestyle modifications including diet, exercise and weight loss. Medication may also be needed but should be used in combination with lifestyle changes for insulin resistance to be managed most effectively.
Lifestyle Changes
Intensive treatment with diet, exercise and weight reduction has been shown to be effective in improving symptoms and restoring ovulation in women with PCOS. In fact, losing just 5-10% of your weight has been shown to reduce insulin levels, improve menstrual function, reduce testosterone (male hormone) levels, improve symptoms of hirsutism (excess hair growth) and acne, restore ovulation and increase fertility.
There is also lots of evidence to show the benefits of diet and exercise in reducing cardiovascular and diabetes risk.
Two large studies have now been conducted looking at the effect of diet and exercise on reducing the risk of developing diabetes in people with impaired glucose tolerance (IGT). IGT is also known as 'pre-diabetes' and means that the blood glucose levels are higher than normal but not high enough to diagnose diabetes - people with IGT have a high risk of going on to develop diabetes. Both studies found a 58% reduction in risk in the groups who undertook lifestyle changes which included dietary modification and regular exercise. This reduction in risk was achieved despite only small to modest weight loss, showing that improving your eating habits and exercising regularly can have a big impact on your health even if you are not losing a great deal of weight. In one of these studies, lifestyle changes were found to be twice as effective as the medication Metformin.
Medical Treatment
Research in women with PCOS and insulin resistance has shown good results with drugs which have traditionally been used to lower insulin levels and improve insulin sensitivity in people with diabetes, the most common being Metformin.
Metformin works by improving the body’s sensitivity to insulin and inhibiting the release of glucose from the liver and many studies have demonstrated its benefits in the management of PCOS. Metformin has been found to help with:
• restoration of normal menstruation, increased ovulation and improved fertility
• a reduction in testosterone levels leading to improvements in acne, reduced facial and body hair growth and decreased hair loss (alopecia)
• reducing blood pressure and improving blood lipids
• weight loss
The result is a reduction in symptoms and a reduction in the risk of health problems associated with PCOS including diabetes and heart disease.
Metformin should be used in combination with lifestyle changes including diet and exercise, and with lipid and blood pressure lowering medications where necessary.
Other drugs used to treat the symptoms of PCOS, which may be used alone or in combination with drugs such as Metformin include:
• Oral Contraceptives – traditionally used to regulate menstrual cycles and improve symptoms of androgen excess, these drugs may cause weight gain and have also been shown to increase insulin resistance. They can reduce the risk of endometrial cancer by causing regular menstruation.
• Anti-androgens – block the effects of androgens, thereby helping to reduce acne and unwanted hair growth. Examples include spironolactone (Aldactone) and Androcur.
• Fertility Drugs such as clomid which help with ovulation, eg Clomiphene Citrate (Clomid)
Surgery, such as ovarian drilling (electrical cautery) may also be used in some cases to destory some of the cysts within the ovary and encourage ovulation.
For more information or to make an appointment, please email info@pcoshealth.com.au or call 9415 4845.