PCOS and Diabetes: how the two affect fertility in women: Dr. Kshitiz Murdia

News Editor, Takmaa News, Kolkata, 13th Sept 2023 : In recent times, there has been a notable increase in the prevalence of two health conditions among women: Diabetes and Polycystic Ovary Syndrome (PCOS). PCOS, as its name suggests, is characterized by the presence of cysts in the ovaries. This condition has far-reaching effects on the endocrine system in women. It disrupts the menstrual cycle, hinders pregnancy, contributes to obesity, and is associated with increased acne production, among other symptoms. On the other hand, diabetes occurs when the body struggles to break down blood glucose, leading to its accumulation. This issue becomes more pronounced as the body develops resistance to the hormone insulin. Notably, insulin resistance is closely intertwined with hormonal imbalances crucial for a woman’s reproductive health, significantly raising the risk of developing PCOS.
Both PCOS and diabetes are closely linked to infertility in women, making it challenging for affected individuals to conceive naturally. Diabetes, particularly in women of reproductive age, has been found to reduce the window of opportunity for conceiving a child by as much as 17 percent. This is due to its influence on the timing of puberty (menarche) and the acceleration of the end of the menstrual cycle (menopause). Women with diabetes often encounter menstrual problems during their reproductive years, including irregular periods, months without menstruation (secondary amenorrhea), or even a complete absence of menstruation (oligomenorrhea). Furthermore, diabetes speeds up the aging process of the ovaries, causing both the quality and quantity of eggs to deteriorate rapidly. This diminishes the chances of natural conception and increases the risk of miscarriage and stillbirth.
It’s important to note that while diabetes and PCOS often coexist, one does not always directly cause the other. Irregular periods are a common experience for women with PCOS due to the hormonal imbalances caused by ovarian cysts. These imbalances lead to elevated levels of testosterone, luteinizing hormone (LH), and estrogen, accompanied by reduced levels of follicle-stimulating hormone (FSH). These factors collectively contribute to irregular menstrual cycles, making regular conception difficult. In women with PCOS, ovulation may not occur, rendering pregnancy impossible without intervention.
Women grappling with both PCOS and diabetes are at a higher risk of gaining excess weight, which in turn can lead to cardiovascular diseases, high blood pressure, and, in some cases, endometrial cancer. Given the shared symptoms of these conditions, addressing insulin resistance, maintaining a healthy weight, and restoring fertility are common treatment goals. However, the specifics of treatment often vary from patient to patient due to individual priorities and needs. These treatments may require several months before noticeable improvements in health occur.
Preventive measures can play a significant role in managing or even preventing these conditions. Early detection of insulin resistance can be crucial in averting diabetes. Healthy lifestyle choices, including a balanced diet low in fat and sugar, rich in whole grains, low-fat dairy, fruits, and vegetables, can lower the risk of both diabetes and PCOS. Weight loss can enhance insulin sensitivity, potentially restarting ovulation and improving fertility. Exercise also contributes to lower blood sugar levels and improved insulin responsiveness, primarily by helping maintain a healthy weight.
Stress is another substantial contributor to insulin resistance and should not be overlooked. Stress can arise from extended work hours and emotional challenges in both professional and personal life. Managing stress through breaks, work-life balance, and open communication with loved ones is essential. Seeking the assistance of a psychologist is a viable option when stress signs become apparent.
Women dealing with diabetes and PCOS can greatly benefit from adopting healthy lifestyle habits. However, in cases where complications persist, assisted reproductive technology (ART), such as in vitro fertilization (IVF), can provide an option for achieving pregnancy. Early symptom detection can significantly improve treatment outcomes, making it advisable for individuals to consult with a gynaecologist, reproductive endocrinologist, or endocrinologist depending on their symptoms and risk factors.