The relationship of insulin insensitivity to menstrual pattern in women with hyperandrogenism and polycystic ovaries

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Abstract
OBJECTIVE Insulin insensitivity is a recognized feature of polycystic ovary syndrome (PCOS) but previous studies have suggested that circulating insulin concentrations are normal in hyperandrogenaemic women with regular cycles. The aim of this study was to examine the relationship between insulin sensitivity and menstrual pattern in women with PCO. DESIGN A cross‐sectional study of insulin sensitivity in a cohort of PCO subjects with oligomenorrhoea compared to women with PCO and regular menstrual cycles and a group of normal control subjects. SUBJECTS Seventy‐two women with polycystic ovaries on ultrasonography were studied. PCO subjects had clinical and/or biochemical evidence of hyperandrogenism; 53 had oligo/amenorrhoea (olig) and 19 had regular menses (reg). Results were compared with 31 control subjects. The groups were matched for age, weight and ethnic origin. METHODS Glucose and insulin responses to 75 g oral glucose were measured. Insulin sensitivity was assessed by the decline in plasma glucose following intravenous insulin (0.05 U/kg). RESULTS Glucose area (mean±SEM) after oral glucose was increased slightly in both PCO groups compared with controls (olig 37.6±1.4, reg 36.0±1.8, control 33.7±0.9 mmol/l h, both P < 0.01). Insulin area median (interquartile range) in response to glucose was significantly greater in the oligomenorrhoeic group (346 (239–734) mU/l h), compared with both PCO with regular cycles (246 (148–355), PPP< 0.01) in the oligomenorrhoeic group (147 ±9.2 /imol/l min) compared to controls (185 ±7.4) but was normal in PCO with regular cycles (182 ±12.5). Insulin sensitivity did not correlate significantly with plasma testosterone or with SHBG levels, but plasma insulin concentrations correlated negatively with SHBG levels (fasting insulin vs SHBG, r= ‐0.47, Pr= ‐0.47, P<0.01). CONCLUSIONS Insulin insensitivity in polycystic ovary syndrome occurs when there is oligo/amenorrhoea but not when the menstrual cycle is regular. This is consistent with PCO and insulin insensitivity being separate abnormalities which when combined are associated with anovulation.