You can treat insulin resistance naturally. However, some women may prefer going on medical treatment. This medication is prescribed by your GP.
As a reminder, insulin resistance is when your liver, muscle and fat cells do not respond to insulin. This causes the pancreas to produce even more insulin in attempt to remove glucose from the blood, so that cells can use it to produce energy.
Increasing your cells sensitivity to insulin will prevent its overproduction and prevent the insulin effect on ovarian follicle maturation which disrupts ovulation. (To remind yourself of this, remind yourself of my blog: "What is insulin resistance and how does it disrupt ovulatory function in PCOS?" by the box below).
Therefore, increasing insulin sensitivity can improve ovulation for fertility and symptoms of high levels of testosterone. Hopefully this image below can help you understand this!
"What drugs can increase insulin sensitivity?"
Metformin (Glucophage)
Metformin is a common drug prescribed to patients with type 2 diabetes to increase insulin sensitivity of muscle, fat and liver cells. This prevents the hyperinsulinemia response to insulin resistance. Metformin can stimulate ovulation by removing the repetitive action of insulin on ovarian theca cells which disrupts follicle development essential for ovulation.
It has been hypothesised that ovarian insulin induced hyperandrogenism is responsible for reducing progesterone levels. Clinical trial research has shown that metformin treated PCOS women have increased progesterone levels. As progesterone is essential for the maintenance of the uterine lining for successful implantation of an embryo, metformin has been shown to decrease the risk early pregnancy loss.
Additionally, increased progesterone levels also decreases the risk of developing endometriosis. This is because progesterone is essential for preventing the excessive growth of endometrial tissue in the uterus.
Finally, metformin can reduce blood sugar levels. This may reduce glucose-induced chronic low-grade inflammation, essential for weight loss. Additionally, weight loss on metformin therapy could be achieved by reducing appetite.
However, metformin is not licensed for treating PCOS in the UK. However, women with insulin resistance can be prescribed this for "off-label" use. The possible side effects of metformin include:
nausea
vomiting
stomach pain
diarrhoea
loss of appetite
Like all drug therapy, metformin can rarely cause severe side effects. This includes lactic acidosis. Lactic acidosis is when lactic acid builds up in the bloodstream which disrupts the pH balance, causing muscle weakness. Therefore, some PCOS women are prescribed alternative insulin sensitizing agents which are more advantageous to them specifically. This will be prescribed and decided by a doctor.
"What are alternative insulin sensitizing therapies, other than metformin?"
Thiazolidinedione (TZD)
Alike metformin, clinical studies have shown that TZD therapy can improve insulin sensitivity of muscle, fat and liver cells. This prevents the hyperinsulinemia response in insulin resistance. This stimulates ovulation by removing the repetitive action of insulin on ovarian theca cells which disrupts follicle development essential for ovulation.
Sitagliptin (Januvia)
This drug therapy prolongs the action of incretin hormones by inhibiting the enzyme which degrades them, this enzyme is dipeptidyl peptidase-4 (DPP4). Incretins are secreted by the intestines in response to food intake to increase insulin secretion to reduce blood sugar levels.
A 12 week study presented that PCOS women that could not tolerate metformin and were treated with sitagliptin had improved insulin resistance.
Byetta (Exenatide for injection)
Another incretin, named glucagon-like peptide 1 (GLP-1) is an important hormone mediating insulin sensitivity. Byetta works by mimicking the effect of GLP-1 to increase insulin sensitivity.
In a study of 60 overweight women with PCOS, byetta improved regular menstrual cycles and improved insulin resistance. Additionally, studies have presented that the combination of metformin and byetta is more efficient than individual treatment.
Although, FDA has reported that 30 patients in a study in 2007 developed a serious condition called pancreatitis. However, as off 2011, no study has identified pancreatitis development in byetta treated PCOS women. Byetta is not recommended for first-line treatment for PCOS, but considered as an alternative.
If you are interested in how these drugs work, make sure to read my blog: "how do insulin sensitizing drugs work?"
Important take home messages...
If you stop insulin sensitizing drug therapy, the domino effect which causes your PCOS is still there.
Therefore diet modifications, exercise and supplementing are required to improve insulin sensitivity when coming off of therapy or during therapy to increase drug efficacy.
If you do not respond well to insulin sensitizing drug therapy, it's likely that your hormone imbalance has a different route cause.
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