PCOS and metabolic syndrome

Polycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age. It is characterized by a range of symptoms, including irregular periods, excessive hair growth, acne, and weight gain. One of the major complications of PCOS can be metabolic syndrome, which can lead to serious health problems if left untreated. In this blog post, we will explore the relationship between PCOS and metabolic syndrome.

What is Metabolic Syndrome?

Metabolic syndrome is a cluster of conditions that occur together and increase the risk of heart disease, stroke, and diabetes. The conditions that make up metabolic syndrome include:

• High blood pressure
• High blood sugar levels
• Excess body fat around the waist
• High levels of triglycerides, a type of fat in the blood
• Low levels of high-density lipoprotein (HDL) cholesterol, also known as "good" cholesterol.

Having one of these conditions doesn't mean you have metabolic syndrome, but having three or more of them can increase the risk of serious health problems, like type 2 diabetes and heart disease.

Metabolic syndrome risks

In addition to PCOS, other risk factors for developing metabolic syndrome include:

• Age— the risk of developing metabolic syndrome increases with age.
• Ethnicity— African American, Hispanic, and people of Native American backgrounds are more likely to develop metabolic syndrome. (Sources: Mayo Clinic, Johns Hopkins Medicine)
• Obesity or overweight— those with obesity (generally a BMI of 30+) or overweight (generally a BMI of 25+) are at a higher risk of developing metabolic syndrome. Please note that the BMI definitions of obesity and overweight can vary depending on ethnic background. It’s important to check with your specific healthcare provider to assess your risk.
• Personal or family history of diabetes, including gestational diabetes.
• Other diseases— Conditions like sleep apnea, nonalcoholic fatty liver disease, PCOS, and more can increase your chances of developing metabolic syndrome.
• Being past menopause— for those assigned female at birth, changes in hormones after menopause can raise the risk of developing a larger waist circumference, high blood sugar levels, and low levels of “good” HDL cholesterol.
• History of heavy drinking or smoking
• Sedentary lifestyle

Your risk also may increase if you take certain obesogenic medications or medications that can impact your blood sugar or blood pressure levels. Please discuss with your doctor before starting any new medication.

What is PCOS?

PCOS is a hormonal disorder that affects women of reproductive age. With PCOS, small sacks of fluid, called cysts, can develop on the ovaries. More research is needed to understand the exact cause(s) of PCOS.

Generally, though, there are three main characteristics of PCOS, and your doctor may diagnose PCOS if you experience at least two of the three.

1. Irregular periods and/or trouble getting pregnant.
2. Higher than normal levels of androgens, a group of hormones that includes testosterone.
3. Polycystic ovaries.
   

PCOS can cause a range of symptoms, including:

• Irregular periods or no periods at all
• Difficulty getting pregnant
• Excessive hair growth on the face, chest, or back (hirsutism)
• Acne
• Weight gain or difficulty losing weight

People with PCOS may also have insulin resistance, which means their bodies have trouble using insulin, a hormone that regulates blood sugar levels. This can be both a symptom and a cause, depending on the individual.

PCOS can increase one’s risk of developing other diseases or complications, including gestational diabetes, sleep apnea, endometrial cancer, stroke, miscarriage, and metabolic syndrome.

How is PCOS Related to Metabolic Syndrome?

People with PCOS are at a higher risk of developing metabolic syndrome than those without the condition. The exact reason for this relationship is not yet clear, but research suggests that insulin resistance and obesity may play a role.

Insulin resistance is a common feature of PCOS, and it can lead to high levels of insulin in the blood. High insulin levels can cause the ovaries to produce more androgens, which can worsen PCOS symptoms. Insulin resistance can also increase the risk of developing type 2 diabetes, which is a component of metabolic syndrome.

Obesity is also common among people with PCOS. Excess body fat, especially around the waist, can increase the risk of developing metabolic syndrome. People with PCOS who have overweight or obese may have a harder time managing their symptoms and may be more likely to develop metabolic syndrome.

While not a diagnostic criterion for PCOS, dyslipidemia has a relatively high rate of prevalence in those with the condition. Dyslipidemia, in turn, can be one of the markers of metabolic syndrome.

Furthermore, PCOS can raise your risk of developing nonalcoholic fatty liver disease and cardiovascular disease, both of which can have overlapping symptoms and causes with metabolic syndrome.

How are Metabolic Syndrome and Insulin Resistance related?

Many people with PCOS also have insulin resistance—as either the cause or the result of their PCOS. And metabolic syndrome and insulin resistance are closely related.

As described previously, insulin resistance is a condition in which the body's cells become resistant to the effects of insulin, a hormone produced by the pancreas that regulates blood sugar levels. As a result, the body produces more insulin to compensate, leading to high levels of insulin in the blood.

These high insulin levels can then contribute to the development of metabolic syndrome.

Excess weight gain —centrally or viscerally— can increase insulin resistance, and this can increase triglycerides, lower HDLc, and increase blood pressure.

The link between insulin resistance and metabolic syndrome is complex, and the exact mechanisms are not fully understood. However, it is clear that insulin resistance can play a significant role in the development of metabolic syndrome—particularly for those with PCOS, who are at risk for developing both.

And strategies to improve insulin sensitivity, such as exercise and weight loss, can also help reduce the risk of developing metabolic syndrome and improve overall health.

How is Metabolic Syndrome Treated in Women with PCOS?

The treatment of metabolic syndrome in women with PCOS is similar to the treatment of metabolic syndrome in the general population. Usually, the first-line defense for metabolic syndrome is lifestyle changes such as regular exercise and a healthy diet.

However, in some cases, medication—or even bariatric surgery— may be recommended to manage the individual components of metabolic syndrome. For example, high blood pressure may be treated with medication, and high cholesterol levels may be managed with statins.

While we recommend discussing your specific case with your medical provider, here are a few common medications used to treat metabolic syndrome or its constituent parts.

GLP-1 medications can help treat metabolic syndrome

You may have heard about GLP-1 medications already. GLP-1 stands for glucagon-like peptide-1 agonists, and these medications are a class of drugs used to treat type 2 diabetes and obesity. They work by mimicking the effects of GLP-1, a hormone produced in the gut and brain that helps regulate blood sugar levels and appetite.

In addition to their use as treatment for diabetes and obesity, GLP-1 medications may also be beneficial in the treatment of metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and diabetes.

GLP-1 medications help treat metabolic syndrome in 4 key ways:

1. Improving insulin sensitivity

GLP-1 medications can improve insulin sensitivity, which is a key component of metabolic syndrome. They do this by increasing the production of insulin in the pancreas and improving the body's response to insulin. This can help lower blood sugar levels, reduce insulin resistance, and improve glucose metabolism.

2. Reducing body weight and fat mass

Obesity is another component of metabolic syndrome, and GLP-1 medications can help reduce body weight and fat mass. They do this by suppressing appetite and promoting satiety, leading to a decrease in caloric intake. GLP-1 medications can also slow down the rate at which food is emptied from the stomach, leading to a feeling of fullness and a reduction in hunger.

3. Lowering blood pressure and cholesterol

High blood pressure and high cholesterol are other components of metabolic syndrome that can lead to heart disease and stroke. GLP-1 medications may help lower blood pressure by reducing the activity of the sympathetic nervous system, which is responsible for regulating blood pressure. They may also lower cholesterol levels by reducing the production of LDL (low-density lipoprotein) cholesterol and increasing the production of HDL (high-density lipoprotein) cholesterol.

4. Reducing inflammation

Inflammation is a key contributor to the development of metabolic syndrome. GLP-1 medications may reduce inflammation by inhibiting the activity of pro-inflammatory cytokines, which are molecules that promote inflammation in the body.

All in all, GLP-1 medications are a promising treatment option for metabolic syndrome. They can improve insulin sensitivity, reduce body weight and fat mass, lower blood pressure and cholesterol, and reduce inflammation. However, further research is needed to fully understand the long-term effects of GLP-1 medications on metabolic syndrome and to determine their optimal use in clinical practice.

Other medications can also help treat metabolic syndrome

There are some medications that might be more affordable than GLP-1s for treating metabolic syndrome. One of the most common is Metformin.

Metformin

Metformin is a medication used to treat type 2 diabetes, but it may also be beneficial in the treatment of metabolic syndrome. Metformin works by reducing the production of glucose in the liver and improving insulin sensitivity. It can help lower blood sugar levels, reduce insulin resistance, and improve glucose metabolism.

There are other medication options

If you are experiencing metabolic syndrome in conjunction with other conditions—e.g. heart disease— your provider might want to discuss other treatment options, including statins.

While we hope this list has been helpful, it’s important to get personalized care. Please discuss with your Clinician to see if medication is right for you.

Conclusion

PCOS and metabolic syndrome are two related conditions that can have serious health consequences if left untreated. Women with PCOS are at a higher risk of developing metabolic syndrome, likely due to insulin resistance and obesity. Early diagnosis and treatment of both conditions can help reduce the risk of serious health problems and improve overall health and well-being.