Role of Insulin in PCOS
Exactly why and how PCOS develops is not quite clear. Most experts, however, now agree that insulin plays a major role. Insulin is a powerful hormone that is released by the body's pancreas in response to eating food—especially carbohydrates. It transports sugar out of the blood and into muscle, fat, and liver cells, where it is converted to energy or stored as fat. Many women with PCOS have insulin resistance. This means that the process of getting the sugar out of the blood and into the cells is defective—the cells are "resistant" to insulin. The pancreas must secrete more and more insulin to get sugar out of the blood and into the cells. High levels of insulin or hyperinsulinemia, can wreak havoc in the body, causing any or all of the following conditions: polycystic ovaries, weight gain and/or difficulty losing weight, increased risk of heart disease by increasing LDL and triglycerides, decreasing HDL and increasing clotting factors.
The discovery of insulin's role in PCOS has brought hopes for better treatment. Treatment is no longer just aimed at treating the individual concerns (i.e. erratic menses, hirsutism, acne, etc.), but instead is now aimed at treating one of the underlying causes—insulin resistance. If insulin resistance is present, it is best treated with diet, exercise and weight loss if needed. Insulin sensitizing medications may be used as well. Most physicians prefer to start with diet and exercise and turn to drugs if needed. Keep in mind that not all women with PCOS have hyperinsulinemia, but the majority do.
