PCOS and Metabolic Syndrome
What makes them connected?
Polycystic Ovary Syndrome and Metabolic Syndrome
From previous posts you already know that the name Polycystic Ovary Syndrome can be misleading and that PCOS is not only about your reproductive system.
I already explained to you what endocrine disorder means and its connection to PCOS (Click here if you haven’t read it yet).
Today we will talk about a second important point that is often mentioned in PCOS research, but not that often clear to us: METABOLIC SYNDROME.
So what is metabolic syndrome?
“Metabolic Syndrome” is also known as “Syndrome X” and was formalized in the late 1980s by Gerald Reaven.
Metabolic syndrome became “popular” in the last decade as the prevalence of metabolic syndrome increased in the general population, especially in women (particularly young ones).
Metabolic syndrome is a collection of cardiovascular risk factors that increase your chance of developing heart disease, stroke, and diabetes.
As we discovered before: syndrome means that a group of symptoms are running together.
Symptoms of Metabolic Syndrome:
- Elevated insulin levels in the blood
- Elevated glucose levels
- Increased blood pressure
- Insulin resistance
- Too much LDL-cholesterol
- Too little HDL (good cholesterol)
- High triglyceride levels in the blood
- Central adiposity
Prevalence of Metabolic Syndrome in women with PCOS
Research shows that metabolic syndrome is more common in women who suffer with PCOS than in the general female population of similar age.
Here are some numbers:
In the USA almost half of women with PCOS have metabolic syndrome (33.4% to 47.3% – depending on diagnostic criteria).
In Italy the prevalence of metabolic syndrome in women with PCOS is much lower – between 8.2% to 16%.
Why are the numbers lower?
Because women in Italy have lower mean body weight and lower triglyceride levels in the blood.
Still in Italy metabolic syndrome is 4 times more frequent in PCOS women than in our non-PCOS female friends.
That shows that independently of your BMI you might be at risk of developing metabolic syndrome.
The answer may lay in insulin resistance, which has been recognised as a common link between PCOS and metabolic syndrome.
Metabolic Syndrome and PCOS - are they interrelated?
Not only women with PCOS are at higher risk of developing metabolic syndrome, but also women with metabolic syndrome very often present the reproductive and endocrine characteristics of PCOS.
But even though PCOS and metabolic syndrome often coexist, they do not invariably overlap.
They share common pathogenic mechanisms (insulin resistance, high triglyceride levels in the blood), but these two syndromes comprise two different clinical entities.
Stress, PCOS and metabolic syndrome?
Are metabolic syndrome symptoms related to chronic stress?
Chronic psycho-social stress is a risk factor for the development of metabolic syndrome.
In one cohort study of healthy women the risk of developing metabolic syndrome was significantly higher among women with greater perceived stress.
You may ask, but why does it matter for me and my PCOS?
Let me explain the connection between those three:
Stress, PCOS and metabolic syndrome.
Women with PCOS have higher levels of perceived stress compared to women without PCOS. Research showed that women with PCOS have altered stress reactivity, including:
– metabolic stress,
– inflammatory stress,
– oxidative stress and
– emotional stress.
Tell me about it….
Women with PCOS have enhanced hypothalamic-pituitary-adrenal (HPA) axis, heart reactivity as well as reduced upregulation of inflammatory markers in response to psycho-social, acute stress compared to non-PCOS women.
Acute stress reaction is when you experience certain symptoms after a particularly stressful event (for example: public speaking). The symptoms develop quickly, but do not last long.
Just one stressful event has a greater influence on your body compared to your non-PCOS friends. What to say when the stress continues for a long period of time?
Well, your risk of developing metabolic syndrome increases significantly.
Insulin Resistance – connection between stress, PCOS and Metabolic Syndrome
Considering hormonal changes caused by chronic stress that cause hyperactivity* of HPA (hypothalamic-pituitary-adrenal – your adrenal system) we can better understand the association between stress and metabolic syndrome.
*You remember hyperactive means producing too many hormones. In this case too many androgens…
But what does it matter for your insulin resistance?
Insulin resistance and central adiposity (fat around your stomach area) affects not only overweight PCOS patients, but also the lean type PCOS patients.
During stress your body produce excess amount of glucocorticoids that:
- Glucocorticoids inhibit secretion and action of insulin leading to insulin resistance.
- Glucocorticoids cause increased production of adipocytes and redistribution of fat, resulting in central adiposity.
- Glucocorticoids lower the level of HDL (the good cholesterol) that distorts the lipid-axis.
That could explain why lean women with PCOS also struggle with insulin resistance.
Remember an extra weight you carry on your belly (even if you are really slim) is not only about your diet or how much you exercise.
Your stress response will play a huge role in PCOS or weight loss for that matter.
Pcos, metabolic syndrome and your behaviour
Ok, so we have explained your body’s biochemical reactions to stress. But there is one extremely important element to this story – your behaviour.
More precisely: change in your behaviour due to chronic stress, that also are marked as pathways that lead to development of Metabolic Syndrome.
People with higher perceived stress have been shown to choose a diet full of products rich in fat and sugars and to spend less time on physical activity.
It makes a lot of sense, I will explain this further in the future posts.
MANAGE YOUR STRESS = MANAGE YOUR PCOS
All of us react differently to stress, all of us find different situations stressful and all of us have different stress thresholds.
There are also many different coping mechanisms to manage stress response.
PCOS involves many different areas of your life. Including hormones, metabolism, sleep, energy levels, mental health, emotions and even relationships or work life.
If you learn to manage your stress effectively you will build emotional resilience that in turn will impact your feelings, mental health, behaviours, metabolism, hormones and PCOS.
When I work with my PCOS clients one of the things we practice is developing coping mechanisms, emotional regulation and relaxation techniques.
Reproductive health is not separated from the rest of your well-being. It is all connected.
Always look at your PCOS management treatment from a wide angle.
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Benson, S., Arck, P. C., Tan, S., Hahn, S., Mann, K., Rifaie, N., Janssen, O. E., Schedlowski, M., & Elsenbruch, S. (2009). Disturbed stress responses in women with polycystic ovary syndrome. Psychoneuroendocrinology, 34(5), 727–735. https://doi.org/10.1016/j.psyneuen.2008.12.001
Bergmann, N., Gyntelberg, F., & Faber, J. (2014). The appraisal of chronic stress and the development of The metabolic syndrome: A systematic review of prospective cohort studies. Endocrine Connections, 3(2). https://doi.org/10.1530/ec-14-0031
Conway, G. (2010). Insulin resistance, the metabolic syndrome and polycystic ovary syndrome. Current Management of Polycystic Ovary Syndrome, 63–70. https://doi.org/10.1017/cbo9781107478343.007
Damone, A. L., Joham, A. E., Loxton, D., Earnest, A., Teede, H. J., & Moran, L. J. (2018). Depression, anxiety and perceived stress in women with and without PCOS: A community-based study. Psychological Medicine, 49(09), 1510–1520. https://doi.org/10.1017/s0033291718002076
Meikle, A. W. (2006). Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. Yearbook of Endocrinology, 2006, 384–385. https://doi.org/10.1016/s0084-3741(08)70443-8
Metabolic syndrome: Causes, symptoms, diagnosis & treatment. Cleveland Clinic. (n.d.).