Many women with diabetes also have Polycystic Ovarian Syndrome (PCOS), which is the most common cause of female infertility affecting an estimated 5 to 10 percent of women in the United States. Although the cause of PCOS is unclear, researchers are trying to determine if there is a link between PCOS and a woman's ability to produce insulin.

Some evidence shows that elevated levels of insulin (also known as insulin resistance) may be a factor in high production of androgen, and this can worsen the symptoms of PCOS. The disorder has a variety of symptoms, including irregular, infrequent menstrual cycles or the absence of any periods at all. When periods do occur, they can be painful and are characterized by heavy, prolonged bleeding.

Symptoms of PCOS

PCOS has a constellation of symptoms, including:

  • Growth of excessive body hair.
  • Exacerbation of acne.
  • A waist measurement greater than 35 inches.
  • A condition called acanthosis nigricans, which presents as dark patches of skin that occur in the armpits, neck folds, waistline folds, and groin.

But for a woman of childbearing age, the most devastating symptoms have to do with her inability to get pregnant.

During ovulation, an egg is released from the ovary by a follicle and travels to the fallopian tube, where it can be fertilized. But in a woman who has PCOS, the follicles are unable to mature enough to release the eggs. The egg is trapped in the follicle, and cysts may form instead.

"Women need a certain level of estrogen in order to ovulate," explains Jill Rabin, MD, chief of ambulatory care, obstetrics and gynecology and head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, NY. "With PCOS, a woman may make enough estrogen so that she is producing cysts in the ovary, but is not able to produce enough to ovulate. Over time the ovaries may enlarge as more and more cysts form."

Treatment for PCOS

Your doctor will consider fertility issues, regulating the menstrual cycle, controlling extra hair growth, and managing insulin resistance syndrome and its associated risks for type 2 diabetes and cardiovascular disease when tailoring your treatment.

If you're not trying to conceive, birth control pills may be prescribed—especially if you have heavy, painful, irregular periods. "Birth control pills basically put the ovaries to sleep," explains Patricia Vuguin, MD, pediatric endocrinologist at Cohen Children's Medical Center in New Hyde Park, NY. "They lower a woman's testosterone level." This treatment helps improve the excessive hair growth as well as acne.

If you are trying to conceive, either an oral medication called Clomid or an injectable medication may be prescribed. Insulin-sensitizing medications or steroids may be used as well since these can induce ovulation.

Unfortunately, the longer the condition goes untreated, the more difficult it can be to treat, Rabin says.

Women with PCOS should be encouraged to maintain a healthy body weight and to follow a balanced diet that is low in carbohydrates to reduce PCOS symptoms. Also, getting regular exercise can promote weight loss and help lower the blood sugar, which helps women use insulin more efficiently.

Jill Maura Rabin, MD, reviewed this article.


"Polycystic Ovarian Syndrome." American Diabetes Association.