Introduction

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting millions of women worldwide, primarily during their reproductive years. This complex condition involves insulin resistance, hormonal imbalances, and metabolic challenges that often lead to symptoms such as irregular periods, excess hair growth, and fertility difficulties.¹

PCOS not only impacts reproductive health but also increases the risk of developing type 2 diabetes (T2D), a chronic condition characterised by the body’s inability to effectively regulate blood sugar. Women with PCOS are significantly more likely to develop T2D due to shared risk factors like insulin resistance, obesity, and genetic predisposition.¹

Despite this close connection, there remains debate around the best ways to screen and diagnose blood sugar issues in women with PCOS, with tests such as the oral glucose tolerance test (OGTT) considered the most reliable. Early diagnosis and targeted screening are crucial for preventing serious complications associated with both conditions, including cardiovascular disease and pregnancy-related problems.²

This article explores the relationship between PCOS and type 2 diabetes, discusses current screening recommendations, and highlights the importance of lifestyle changes and medical support to manage these interconnected health concerns. Women affected by PCOS should be empowered with knowledge and tools to reduce their diabetes risk and improve overall quality of life.

Understanding PCOS

PCOS is a complex, hormone-related long-term condition that mainly affects women of reproductive age (typically between 15 and 49 years of age).^1,2 It affects around 6-15% of women around the world, significantly impacting their health and quality of life.³ With PCOS, the body doesn’t respond properly to insulin, and when it produces extra insulin to compensate, this can lead to the ovaries generating elevated levels of testosterone.⁴ These high levels of testosterone can result in physical signs such as extra fat, facial and/or body hair.⁴

PCOS is considered to be a complex condition because it is caused by a complex combination of genetic, environmental, and hormonal factors.⁵ In addition, the symptoms of the condition often change, making it a difficult condition to manage.³

In terms of fertility, PCOS is the leading cause of irregular periods and causes trouble with ovulation.⁶ It also raises the risk of pregnancy-related problems, such as miscarriage, gestational diabetes and high blood pressure during pregnancy.⁶

Even after menopause, the hormone issues seen in PCOS often continue, but getting a diagnosis can take time.⁶ Treatment is often inconsistent because we still don’t fully understand what causes PCOS, but it can often include lifestyle changes and medications.⁶ As PCOS can also significantly impact mental health, many women may seek support for related anxiety, depression, eating disorders, and poor body image, all of which contribute to reduced overall quality of life.

What is type 2 diabetes?

Globally, 415 million people live with diabetes, and nearly half of this number are unaware that they live with the condition.T2D is the most common form, representing over 90% of all cases.⁷

T2D is a serious health condition that affects how the body uses sugar. This type of diabetes happens when the body doesn’t respond well to insulin (a hormone that controls blood sugar), which eventually leads to high blood sugar.² Both genetics and environmental factors can play a role in causing T2D. Signs and symptoms of T2D may not show up right away, but in some cases, skin darkening in certain areas or problems with weight loss can be early signs.²

T2D tends to run in families and is more common in people who are overweight, especially women. Whilst the ageing population makes up the majority of T2D cases, an increasing trend is starting to emerge where younger people are also affected by the condition.⁷ Women with diabetes, especially if diagnosed at a young age, might have issues with their menstrual cycles or trouble getting pregnant.^{5, 6} 

This condition has become much more common in recent decades due to rising obesity rates, less physical activity, and an ageing global population.⁷ T2D can be hard to manage, but there are many treatment options. This mainly includes better blood sugar control, but in the past few years, new pills have become available, which offer more choices. Lifestyle changes like eating healthy, losing weight, and staying active are key to managing diabetes.² The best results for patients come from early diagnosis and then providing care that’s tailored to their needs. This includes education, support, and working closely with a healthcare team to manage the disease based on current medical guidelines.

The link between PCOS and type 2 diabetes

PCOS and T2D are closely connected. This is because women with PCOS tend to have a higher risk of blood sugar problems.⁵ Additionally, PCOS and T2D share some of the same causes, such as insulin resistance.³ They also share similar symptoms such as hormone changes and metabolic problems, and shared risk factors like obesity, genetics, and leading a sedentary lifestyle.^3,8 Despite this, it is still debated whether PCOS itself increases the risk of T2D.³

Women with PCOS are four times more likely to get T2D.¹ When PCOS and T2D occur together, it can negatively affect the reproductive system.⁸ Women can experience more difficulty getting pregnant and a greater risk of miscarriage. This is mainly a result of insulin resistance affecting the lining of the uterus and placenta.⁸

Getting tested and diagnosed

As more people are being diagnosed with T2D at younger ages, the number of women affected by PCOS is rising. This is becoming a serious public health concern.⁸

PCOS is not regularly identified or screened in women with T2D. Without targeted screening, many women with T2D may go undiagnosed for PCOS and miss out on tailored interventions that can help them manage their symptoms.⁸

Currently, there is no clear agreement on how to screen for blood sugar problems in these women.⁵ Doctors now recommend that all women with PCOS be checked for signs of glucose intolerance (trouble processing sugar)². There are three main blood tests for insulin and glucose:

• Oral glucose tolerance test (OGTT): Measures how your body handles sugar over 2 hours. It is often recommended that, although more time-consuming, it is more accurate
• Fasting blood sugar: Measures blood sugar after 8 hours without food. However, it is not reliable alone and may miss up to 40% of PCOS cases
• HbA1c test (Glycated Haemoglobin): Reflects average blood sugar over 3 months. It is not recommended for the diagnosis of PCOS as it is affected by irregular periods, anaemia, and ethnicity

It is recommended that all young women with PCOS should be tested using an OGTT, even if they have a normal BMI. This is the best way to catch blood sugar issues early and start treatment when needed.⁵ It’s very important to diagnose PCOS early because, if left untreated, it can lead to serious health problems such as high blood pressure, high blood sugar, and cholesterol problems.⁹

Seeking support from your healthcare provider

Risk factors for PCOS and T2D include family history of diabetes, obesity, and symptoms of high blood sugar. For women identified as high risk, it is important to proactively seek help from healthcare providers to discuss opportunities for early testing, risk reduction strategies, and the creation of a personalised health plan tailored to individual needs. Regular follow-up testing, particularly with the OGTT, is recommended to monitor blood sugar levels and catch any changes early.⁵

Healthcare providers, including gynaecologists, dietitians, and mental health professionals, can work collaboratively to offer comprehensive care. This multidisciplinary approach ensures that women receive support not only for managing physical symptoms, but also for mental health conditions such as anxiety or depression, which are common in PCOS.⁵

In terms of treatment, healthy eating, regular physical activity, and lifestyle changes are key and can be very effective in improving blood sugar levels in women with PCOS. Education, ongoing support, and open communication with your care team are beneficial for effectively managing PCOS and reducing the risk of developing T2D.⁵

Summary

In conclusion, PCOS is a complex condition that significantly increases the risk of developing T2D in women. The shared factors of insulin resistance, obesity, and genetics link these two conditions closely, making early detection and management essential. Despite ongoing debates about the best screening methods, the OGTT remains the most effective tool to identify blood sugar problems in women with PCOS, even for those who are young or have a normal weight.

Regular monitoring and timely diagnosis can help prevent serious complications such as cardiovascular disease, pregnancy issues, and worsening metabolic health. Lifestyle modifications, including a balanced diet, physical activity, and weight management, play a critical role in reducing diabetes risk and improving overall well-being in women with PCOS. Furthermore, mental health support should be integrated into care plans due to the psychological impact of PCOS. It is important for women and healthcare providers to work together in creating personalised strategies for screening, prevention, and treatment. By increasing awareness and understanding of the link between PCOS and T2D, we can empower women to take control of their health and improve their quality of life.