Menstrual Problems, Weight Gain and Type 2 Diabetes… Is There a Link?

By Joy Pape, RN, BSN, CDE, WOCN

Experts are finding out that some women who have type 2 diabetes also may have a related condition called Polycystic Ovarian Syndrome (PCOS). In fact, many women with diabetes may have had PCOS for years. They may have noticed earlier in their lives that they didn’t easily tolerate eating sweets or large meals. They would get weak and shaky between meals, get headaches, and become tired and irritable. The only thing that made them feel better for a short time was eating more sweets and drinking coffee or regular soda. The problem with this routine is that it just started the roller coaster over again.

If this sounds like you or someone you know, read on—there’s more to the story.

Most women note that this group of problems started in their teens. Maybe they didn’t start getting their period when their friends did, or their periods were irregular. Maybe they had acne or skin problems. They might have had hair growth or hair loss in places they shouldn’t have, such as on the face or head. Some women didn’t notice any of these symptoms until they wanted to get pregnant. They found out that they were infertile and could not get pregnant. Still other women just knew things weren’t right.

As women with these symptoms get older, many develop high blood pressure and abnormal blood lipid (fat) levels. They gain even more weight, especially in their stomach area. As time goes on, many develop type 2 diabetes and heart disease.

What do these symptoms have in common?

Some women have one or two of these problems at some time in their lives. Women who have several of these problems may have PCOS. It is called a syndrome rather than a disease because there can be a variety of symptoms.

There is no single test to diagnose PCOS. Most women find out they have it when they are evaluated for related symptoms, such as:

• Irregular menstrual cycles.
• Weight gain, especially in the abdomen.
• Abnormal vaginal bleeding.
• Excess hair growth or hair loss in unexpected areas.
• Skin problems.
• Depression and mood swings.
• Infertility.
• Miscarriages.
• Heart disease.
• Type 2 diabetes.

The diabetes connection

You may wonder how all this is related to diabetes. The symptoms of PCOS are caused by a hormonal imbalance. We have many hormones in our bodies, and they “speak” with one another. If there is too much or too little of one, it can affect the others.

With PCOS, there is an increase in male hormones (All women’s bodies produce a small amount of male hormones like testosterone; women with PCOS produce more than the normal amount). This can cause insulin resistance in these women, which then leads to type 2 diabetes. These women’s bodies are not able to make enough insulin, and the body isn’t able to correctly use the insulin that the pancreas does make.

The exact mechanism by which PCOS works is still not completely understood. Some of the symptoms of PCOS are related to the increase in male hormone levels, and some to excess insulin. Excess body hair and thinning hair on the head are related to excess male hormones. The development of type 2 diabetes and heart disease are related to excess insulin. Early on, many women with PCOS have higher-than-normal blood glucose levels. Many of these women get type 2 diabetes earlier in life and during pregnancy, which is known as gestational diabetes.

If you think you have PCOS, talk with your health care provider. Not all health care providers are familiar with PCOS, so try to find a provider who is. You might find that your gynecologist or obstetrician is more familiar with PCOS than your primary care provider.

The treatment of PCOS is targeted more toward prevention of long-term problems, such as type 2 diabetes and heart disease. Treatments also try to control the symptoms.

If you have type 2 diabetes and think you have PCOS, continue to learn all you can about managing your diabetes. If this is new information to you, hopefully it will help you put the pieces of the PCOS puzzle together. If you know someone with these symptoms, share this information with her. Maybe you can help her, too.

For more information about PCOS, visit the Polycystic Ovarian Syndrome Association Web site (www.pcosupport.org) or call (877) 775–PCOS (7267).

Reviewed by Robert Ehrman, MD