Metabolic

Birth control pills can lower the risk of type 2 diabetes in women with PCOS, a study shows

A study led by the University of Birmingham has shown for the first time that birth control pills can reduce the risk of type 2 diabetes in women with polycystic ovarian syndrome (PCOS) by more than a quarter.

The research also shows that women with PCOS are twice as likely to develop type 2 diabetes or prediabetes (dysglycemia) – underscoring the urgent need to find treatments to reduce that risk.

In addition to the risk of type 2 diabetes, PCOS – which affects 10% of women worldwide – has long been linked to a number of other conditions such as endometrial cancer, cardiovascular disease, and non-alcoholic fatty liver disease (NAFLD).

Symptoms of PCOS include irregular or no periods, which can lead to fertility problems, and many suffer from unwanted hair growth (known as “hirsutism”) on the face or body, hair loss on the scalp, and oily skin or acne. These symptoms are caused by high levels of hormones called androgens in the blood of women with PCOS.

Women with PCOS also often struggle with weight gain, and the cells in their body are often less responsive to insulin – the hormone that allows the body to absorb glucose (blood sugar) into cells for energy. This decreased response to insulin can lead to increased blood sugar levels and cause the body to produce more insulin, which in turn causes the body to produce more androgens. The androgens further increase insulin levels – which drives a vicious circle.

The team of scientists, led by the University of Birmingham, conducted two studies to firstly determine the risk of developing type 2 diabetes and prediabetes in women with PCOS and, secondly, to examine the effects of using combined oral contraceptives, which are often referred to as ” the pill “on the risk of type 2 diabetes and prediabetes in women with PCOS. The pill is often given to women with PCOS to help make menstrual bleeding more regular.

Using UK GP medical records of 64,051 women with PCOS and 123,545 matched control women without PCOS, they first conducted a large population cohort study to analyze risk for type 2 diabetes and prediabetes. They found that women with PCOS had twice the risk of type 2 diabetes or prediabetes compared to women without PCOS. They also identified hirsutism (excessive hair growth) – a clinical sign of high androgen levels – as a significant risk factor for type 2 diabetes and prediabetes in women with PCOS.

To investigate the effects of the pill on type 2 diabetes or prediabetes, the researchers – including experts from the RCSI University of Medicine and Health Sciences – then conducted another nested case-control study of 4,814 women with PCOS. The scientists found that the use of combined oral contraceptives reduced the chances of developing type 2 diabetes and prediabetes in women with PCOS by 26%.

The researchers behind the study, published today in Diabetes Care, now plan to conduct a clinical study to further substantiate their findings, in the hope that it will lead to changes in global health policy.

We knew from previous, smaller studies that women with PCOS are at increased risk of type 2 diabetes. What is important about our research, however, is that, for the first time in a very large population-based study, we were able to present new evidence to show that we have a potential treatment option – combined oral contraceptives – to prevent these very serious health risks. “

Wiebke Arlt, co-senior author of the study and professor, director of the Institute for Metabolism and Systems Research, University of Birmingham

Joint lead author Dr. Michael O’Reilly, Emerging Clinician Scientist on the Health Research Board and Clinical Associate Professor at RCSI University of Medicine and Health Sciences, added, “We believe the pill reduces the risk of diabetes by dampening the effects of androgens Pill contains estrogens, which increase a protein in the blood called sex hormone binding globin (SHBG). SHBG binds androgens, making them inactive. When the pill is taken, SHBG increases. This reduces the amount of unbound, active androgens, which reduces their impact on insulin and diabetes risk. “

Joint lead author Anuradhaa Subramanian, also from the University of Birmingham, added, “With one in ten women living with PCOS, a lifelong metabolic disorder, it is incredibly important that we find ways to reduce the associated health risks.”

Co-senior author Krish Nirantharakumar, Professor of Health Data Science and Public Health at the Institute of Applied Health Research, University of Birmingham, added, “Our data shows that women of normal weight with PCOS are also at increased risk of type 2 diabetes and prediabetes. This is in line with our earlier finding of an increased risk of NAFLD in women of normal weight with PCOS and further challenges the notion that PCOS-related metabolic complications are only relevant in the context of obesity. PCOS-specific factors, including androgen excess, underpin the increased metabolic risk. “

Source:

Journal reference:

Kumarendran, B., et al. (2021) Polycystic Ovarian Syndrome, Combined Oral Contraceptives, and the Risk of Dysglycemia: A Population-Based Cohort Study with a Nested Pharmacoepidemiological Case-Control Study. Diabetes treatment. doi.org/10.2337/dc21-0437.

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