A frequent but poorly understood syndrome
PCOS is a hormonal disorder that affects about 1 in 10 women of childbearing age. Due to too high production of male hormones – androgens – the ovaries experience a build-up of follicles that disrupt ovulation.
Patients usually have a disrupted menstrual cycle and may have difficulty having a baby. Many patients also suffer from hirsutism, that is to say, excessive hairiness, hair loss or even acne, linked to the high level of androgens.
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A higher risk of type 2 diabetes
Patients with PCOS often have a poor response to insulin, the hormone that regulates the level of sugar in the blood. The body’s resistance to insulin (or insulin resistance) directly promotes the onset of type 2 diabetes, the most common type of diabetes. The excess androgens in PCOS also decrease the body’s ability to process insulin.
A study conducted by a team of researchers from the University of Birmingham and published in Diabetes Care in October 2021 included 64,051 women with PCOS and 123,545 women without (control group). The authors find that patients with PCOS were twice as likely to develop type 2 diabetes and pre-diabetes than women without.
The mechanisms that link PCOS and insulin resistance are still poorly understood. Among the possible explanations, patients are often overweight, which tends to promote insulin resistance.
Most “even patients of normal weight are not spared“by the higher risk of diabetes, warns the endocrinologist Dr Michel Pugeat.
The pill could reduce the risk of diabetes
The researchers found that the risk of type 2 diabetes was less common in patients who had taken an estrogen-progestogen pill, with a risk reduction of about 25%. This observation “shows for the very first time that there may be a cure“to prevent the onset of diabetes in these patients,” said one of the researchers, Wiebke Arlt.
Taking a contraceptive pill reduces the action of androgens: it would be possible to end the vicious androgen / insulin cycle, and therefore reduce the risk of diabetes. This is still only a hypothesis, made from retrospective observations, and it will have to be confirmed by large clinical trials.
Better diagnose PCOS
But, beyond the risk of diabetes itself, the endocrinologist considers it especially necessary to diagnose PCOS as early as possible, from adolescence. Patients can thus be quickly invited to adopt habits – physical exercise, diet – which will limit the risk of diabetes.
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