Flip a coin. Heads or tails? If you’re a woman living with polycystic ovarian syndrome (PCOS), your odds of developing diabetes may be about the same as a coin flip. More than half of women with PCOS will develop prediabetes or diabetes by age 40. What Is PCOS? A woman’s ovaries have small sacs called follicles. Normally, they hold eggs and release them when the eggs are mature. But with PCOS, these follicles bunch together, creating cysts. Eggs develop, but they aren’t let go. In women with PCOS, the ovaries make too many androgens (male hormones such as testosterone). The androgens affect normal egg development and release. PCOS affects between 5% and 10% of women of childbearing age. Experts don’t know what causes it, but they suspect genetics may be involved. PCOS Symptoms and Diagnosis PCOS is the most common cause of infertility in women. Common symptoms include: Anxiety Dandruff Thinning hair or hair loss Obesity or weight gain Unusual hair growth on the face, toes, thumbs, belly, chest, or back Depression Heavy, sustained bleeding during periods Irregular or infrequent periods, or missing periods Lack of ovulation, leading to infertility Painful periods Oily skin or acne Pain in the pelvic area Sleep apnea, a condition in which breathing stops during sleep To diagnose PCOS, your health care provider will look at your medical history and do a physical exam. He or she will also do a pelvic exam or vaginal ultrasound to check your ovaries. You may have a blood test to check your hormones, insulin, and blood glucose. The Link Between PCOS and Diabetes Several published large studies clarify the relationship between PCOS and diabetes. One study published in Diabetes followed 225 Italian women with PCOS for up to 17 years. By the end of the study, nearly 40% developed diabetes. Only about 6% of healthy Italian women of the same age have diabetes. In another study, Swedish researchers looked at 87 women without PCOS and 84 with PCOS. After 14 years, 21% of PCOS patients developed diabetes, compared to 4.5% of those without the condition. Overall, women with PCOS have a 3- to 7-fold higher diabetes risk. PCOS patients who are obese, or have a large waist circumference, are especially at risk . Why is diabetes so common in women with PCOS? Some evidence suggests that high androgen hormones may be a result of an underlying metabolic problem. The same metabolic problem could be related to diabetes. High androgens might also cause insulin resistance, which can lead to diabetes. Research shows that giving androgens to healthy women leads to insulin resistance. On the other hand, blocking androgens improves insulin sensitivity. Do You Need a Diabetes Test? You should be screened for diabetes if you have PCOS and one of the following: A family history of type 2 diabetes Acanthosis nigricans, a skin condition that causes darker, thicker skin on some areas of your body High levels of androgen hormones and no ovulation Obesity (a BMI greater than 30) The guidelines above are general recommendations from the American Society for Reproductive Medicine. Your health care provider may suggest a different plan. Treating Diabetes and PCOS The primary treatment for women with diabetes and PCOS is a healthy diet and lifestyle. Eat plenty of lean meats, fruits, vegetables, and whole grains. Limit sugars and processed foods. A healthy eating plan lowers blood glucose levels and helps your body use insulin. Keep your weight at a healthy level. If you’re overweight, losing just 10% of your weight can make your period more normal. Shedding only a few pounds can help control diabetes. Your health care provider may also prescribe the diabetes medication metformin (Glucophage). It has been shown to help with PCOS symptoms. Key Takeaways More than half of women with PCOS will develop prediabetes or diabetes by age 40. Those who are obese or have a large waist circumference are especially at risk. PCOS is the most common cause of infertility in women. Symptoms include unusual hair growth, irregular periods, and pelvic pain. There are specific diabetes screening guidelines for women with PCOS. The primary treatment for women with diabetes and PCOS is a healthy diet and lifestyle. Your health care provider may also prescribe metformin (Glucophage).