PCOS has no known cure (polycystic ovary syndrome). Birth control tablets, on the other hand, can be used for long-term treatment in women who do not want to become pregnant. The birth control pills used to treat PCOS are combination hormonal birth control pills, which include both estrogen and progestin.
A study done by the University of Birmingham found that the contraceptive pill can cut the incidence of type 2 diabetes by more than a quarter in women with polycystic ovarian syndrome for the first time (PCOS). The study also discovered that women with PCOS have twice the chance of acquiring type 2 diabetes or pre-diabetes (dysglycemia), emphasizing the critical need for treatments to lower this risk.
In addition to the risk of type 2 diabetes, PCOS, which affects 10% of women worldwide, has been linked to a number of other long-term illnesses, including endometrial cancer, cardiovascular disease, and non-alcohol related fatty liver disease (NAFLD).
PCOS symptoms include irregular or absent periods, which can lead to fertility concerns, and many women experience unwanted hair growth (known as hirsutism) on the face or body, hair loss on the scalp, and oily skin or acne. These symptoms are produced by elevated amounts of androgen hormones in the blood of PCOS women.
Previous studies have shown that women with PCOS have an elevated risk of type 2 diabetes. What is remarkable about our research is that we were able to present fresh evidence from a very large population-based study to show for the first time that we have a potential treatment option – combination oral contraceptives – to prevent this extremely substantial health risk.
Professor Wiebke Arlt
Women with PCOS frequently suffer with weight gain, and their cells are frequently less receptive to insulin – the hormone that permits the body to take glucose (blood sugar) into the cells for energy. This decreased insulin response can result in elevated blood glucose levels and drive the body to produce more insulin, which in turn stimulates the body to produce more androgens. Androgens raise insulin levels even further, creating a vicious spiral.
The team of scientists led by the University of Birmingham conducted two studies: one to identify the risk of developing type 2 diabetes and pre-diabetes in women with PCOS, and the other to investigate the impact of combined oral contraceptives, commonly referred to as ‘the pill,’ on the risk of type 2 diabetes and pre-diabetes in women with PCOS. Women with PCOS are frequently prescribed the pill to enhance the regularity of their monthly bleeding.
They conducted a large population-based cohort study to examine the risk of type 2 diabetes and pre-diabetes using UK patient GP data of 64,051 women with PCOS and 123,545 matched control women without PCOS. They discovered that women with PCOS were twice as likely as those without PCOS to develop type 2 diabetes or pre-diabetes. They also discovered that hirsutism (excessive hair growth), a clinical marker of elevated androgen levels, is a substantial risk factor for type 2 diabetes and pre-diabetes in PCOS women.
The researchers, who included experts from the RCSI University of Medicine and Health Sciences, then conducted a nested case control study of 4,814 women with PCOS to assess the pill’s impact on type 2 diabetes or pre-diabetes. The researchers discovered that using combination oral contraceptives lowered the risk of acquiring type 2 diabetes and pre-diabetes by 26% in women with PCOS.
The researchers behind the study, which was published today in Diabetes Care, are now organizing a clinical trial to further validate their findings in the hope that it will lead to changes in worldwide healthcare policy.
Professor Wiebke Arlt, Director of the Institute of Metabolism and Systems Research at the University of Birmingham and co-senior author, stated: “Previous, smaller studies have shown that women with PCOS have an elevated risk of type 2 diabetes. What is remarkable about our research is that we were able to present fresh evidence from a very large population-based study to show for the first time that we have a potential treatment option – combination oral contraceptives – to prevent this extremely substantial health risk.”
Dr Michael O’Reilly, Health Research Board Emerging Clinician Scientist and Clinical Associate Professor at RCSI University of Medicine and Health Sciences and co-first author, added: “We hypothesize that the pill lowers the risk of diabetes through inhibiting androgen action. What is the procedure for this? The pill contains oestrogens, which raise blood levels of a protein called sex hormone-binding globin (SHBG). SHBG binds androgens, rendering them inactive. As a result, if the tablet is consumed, SHBG rises. This reduces the amount of unbound, active androgens, which reduces their impact on insulin and diabetes risk.”
“With one in every ten women living with PCOS, which is a life-long metabolic disease, it is very crucial that we develop ways to reduce its associated health risks,” said co-first author Anuradhaa Subramanian of the University of Birmingham.
Co-senior author Krish Nirantharakumar, Professor in Health Data Science and Public Health at the University of Birmingham’s Institute of Applied Health Research, added: “Importantly, our data highlight that normal weight women with PCOS were also at increased risk of type 2 diabetes and pre-diabetes. This parallels our previous finding of increased NAFLD risk in normal weight women with PCOS, further challenging the notion that PCOS-related metabolic complications are only relevant in the context of obesity. These data suggest that, rather than obesity in isolation, PCOS-specific factors, including androgen excess, underpin the increased metabolic risk.”
