Baptiste, C. G., Battista, M. C., Trottier, A., & Baillargeon, J. P. (2010). Insulin and hyperandrogenism in women with polycystic ovary syndrome. The Journal of steroid biochemistry and molecular biology, 122(1-3), 42-52. https://doi.org/10.1016/j.jsbmb.2009.12.010
Baptiste CG, Battista MC, Trottier A, Baillargeon JP. Insulin and hyperandrogenism in women with polycystic ovary syndrome. The Journal of steroid biochemistry and molecular biology. 2010;122(1-3):42-52. doi:10.1016/j.jsbmb.2009.12.010
Baptiste, Catherine G., et al. "Insulin and hyperandrogenism in women with polycystic ovary syndrome." The Journal of steroid biochemistry and molecular biology, vol. 122, no. 1-3, 2010, pp. 42-52.
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RRM Academy Synopsis
Insulin action is linked to high androgens in PCOS, review says
Insulin appears to contribute to high androgen levels in women with PCOS, says a 2010 review of past studies. PCOS (polycystic ovary syndrome) now also goes by polyendocrine metabolic ovarian syndrome (PMOS). The review also covers body fat, fatty acids and weight loss.
Key Findings
The review reports that 6–10% of women in their childbearing years have PCOS. It says up to 70–80% of women with PCOS show visible signs of excess androgens.
Insulin sensitivity averages 35% to 40% lower in women with PCOS than in matched controls, about the level found in women who have non-insulin-dependent diabetes mellitus.
In lean women with PCOS and normal insulin levels and sensitivity, lowering insulin with diazoxide reduced free testosterone and androstenedione.
In the authors' own trial of 100 non-obese women with PCOS and normal insulin levels, testosterone fell in the groups given insulin-sensitizing drugs, compared with placebo.
In a trial of 343 overweight infertile women, pregnancy rates were 20% with lifestyle modification and 14.8% with clomiphene plus metformin. The difference did not reach statistical significance.
Interpretation
The paper is a narrative review: the authors discuss earlier studies, including their own trial, and pool no data. Much of the mechanism comes from cultured cells, tissue biopsies and animal studies, so it suggests a way insulin could raise androgens. The authors say the main theories remain unconfirmed and that more research is needed. Two trials they cite enrolled 30 and 28 women. The review addresses women with PCOS only.
RRM Context
Restorative reproductive medicine starts from the underlying causes of a cycle that fails to ovulate. The review names insulin as one candidate cause, with body fat and fatty acids feeding into it. The authors add genes and environment as further contributors and call the picture unresolved.
Our editorial summary of this paper, not the article's abstract.
Abstract
Polycystic ovary syndrome (PCOS) is a very common endocrine disorder characterized by chronic anovulation, clinical and/or biochemical hyperandrogenism, and/or polycystic ovaries. But most experts consider that hyperandrogenism is the main characteristic of PCOS. Several theories propose different mechanisms to explain PCOS manifestations: (1) a primary enzymatic default in the ovarian and/or adrenal steroidogenesis; (2) an impairment in gonadotropin releasing hormone (GnRH) secretion that promotes luteal hormone (LH) secretion; or (3) alterations in insulin actions that lead to insulin resistance with compensatory hyperinsulinemia. However, in the past 20 years there has been growing evidence supporting that defects in insulin actions or in the insulin signalling pathways are central in the pathogenesis of the syndrome. Indeed, most women with PCOS are metabolically insulin resistant, in part due to genetic predisposition and in part secondary to obesity. But some women with typical PCOS do not display insulin resistance, which supports the hypothesis of a genetic predisposition specific to PCOS that would be revealed by the development of insulin resistance and compensatory hyperinsulinemia in most, but not all, women with PCOS. However, these hypotheses are not yet appropriately confirmed, and more research is still needed to unravel the true pathogenesis underlying this syndrome. The present review thus aims at discussing new concepts and findings regarding insulin actions in PCOS women and how it is related to hyperandrogenemia.
