Using continuous glucose monitoring in people with PCOS
Improving metabolic health can often alleviate symptoms of PCOS and continuous glucose monitors are one of the best tools we have.
Polycystic ovary syndrome (PCOS) is a complex metabolic and reproductive disorder affecting millions of women. Although symptoms vary by person, PCOS involves some combination of hyperandrogenism, ovulatory dysfunction, and polycystic ovaries on imaging. The condition can be painful and cause a host of symptoms and complications that affect quality of life.
Symptoms and associated conditions include acne, hirsutism (male-pattern facial and body hair distribution in women), obesity, Type 2 diabetes, non-alcoholic fatty liver disease, menstrual cycle dysfunction including anovulation (not ovulating), and depression and anxiety. PCOS is also a leading cause of infertility.
Somewhere between 6% and 21% of women globally have PCOS, making it one of the most common endocrine conditions affecting women in their reproductive years. However, the World Health Organization reports that up to 70% of people with PCOS may be undiagnosed.
PCOS is deeply connected to metabolic health. The hormone dysregulation that occurs in PCOS impacts insulin, a core metabolic hormone, and the relationship is bidirectional: poor metabolic health can worsen PCOS, and PCOS can lead to metabolic dysfunction.
Because of these connections, continuous glucose monitoring (CGM) has been used frequently in PCOS research over the past decade. It’s a tool that can help those with PCOS keep their glucose (blood sugar) levels more stable, which can help manage and reduce PCOS symptoms.
The Link Between PCOS and Insulin Resistance
Although PCOS has different phenotypes, insulin resistance is a common characteristic among all phenotypes. Up to 95% of people with PCOS also have insulin resistance and hyperinsulinemia (high insulin levels), according to a review in the Journal of Ovarian Research.
Insulin is a hormone produced in the pancreas. When glucose enters the bloodstream, the pancreas releases insulin, which signals cells to uptake glucose. Frequent blood sugar spikes and chronically high blood sugar lead to high insulin levels, which can make cells resistant to insulin’s signaling, known as insulin resistance. The result is high blood sugar and high insulin levels.
The high insulin levels caused by insulin resistance stimulate the ovaries’ theca cells, which have insulin receptors, to produce more androgens (e.g., testosterone). Hyperandrogenism (high androgen levels) is another major characteristic of PCOS. Insulin can also encourage the production of more theca cells, which can cause even higher androgen levels.
High androgen levels drive the symptoms of PCOS, but high androgens can also further exacerbate insulin resistance, creating a vicious cycle. Androgens can also cause a redistribution of fat to the belly. An increase in fat cells can further worsen insulin resistance.
Elevated blood sugar levels, insulin resistance and PCOS are all intertwined. Keeping blood sugar more stable often helps people with PCOS manage and mitigate symptoms, including acne, obesity, and infertility.
Continuous Glucose Monitoring (CGM) Technology
CGMÂ allows people to monitor their glucose levels in real time to see how their diet and habits impact their blood sugar. Users place a small sensor, about the diameter of a quarter, on their body, usually on their upper arm. The sensor has a tiny filament that painlessly enters the interstitial fluid just under the skin, where it measures glucose. This sensor sends a signal to their smartphone or handheld monitoring device, where they can read their glucose levels.
Bio-individuality means the same foods can affect people differently. Lifestyle factors, like sleep, stress, and physical activity, also affect our glucose levels. That’s why the real-time feedback of a CGM is the best way to connect your lifestyle choices with your blood sugar patterns, and identify the foods and habits that keep your blood sugar stable.
If you have PCOS, maintaining stable blood sugar with the help of a CGM can reduce surges of insulin that contribute to insulin resistance, and ultimately help manage symptoms.
Case Studies and Research Findings
We don’t yet have large-scale studies on the use of CGM for people with PCOS. However, clinical trials are underway. Smaller, older studies show the potential benefit of CGM use.
One study from 2012, for example, involved 28 women with PCOS and hyperandrogenism and 25 with PCOS but without hyperandrogenism. All participants wore a CGM for 72 hours. The researchers found that the participants with hyperandrogenism had higher minimum and mean glucose readings than those with normal androgen levels. The researchers concluded that CGM may help identify people with PCOS who are at risk for developing Type 2 diabetes.
Other studies show how keeping blood sugar more stable by eating a metabolically friendly diet can benefit people with PCOS.
- One 2013 study featuring 21 people with PCOS demonstrated that a low-glycemic index diet for 12 weeks improved insulin sensitivity in people with PCOS. Such a diet prioritizes foods that won’t rapidly spike blood sugar.
- A 2019 study of 28 people with PCOS and 34 without it demonstrated that a six-month low-glycemic diet produced a significant reduction in total testosterone in women with PCOS. Participants with PCOS also experienced an increase in sex hormone binding globulin (SHBG). Low SHBG can further contribute to high androgen levels, exacerbating PCOS symptoms. The participants with PCOS on the low-glycemic index diet also saw improvements in acne and hirsutism issues, and 80% experienced an improvement in menstrual regularity.
- A 2020 study put 14 people with PCOS who were also overweight on a ketogenic Mediterranean diet for three months. They experienced a significant decrease in glucose and insulin levels and improvements in insulin sensitivity. Their triglycerides and cholesterol levels also improved, their testosterone levels decreased, and their SHBG increased.
Although we need more studies to show how CGM may help people with PCOS, some women are taking charge of their health and using one. These Levels members shared their PCOS and CGM success stories:
- Abby O’Connor uses CGM to keep tabs on her nutrition, improve energy, and ease PCOS symptoms.
- Natalie Ellis, the cofounder of BossBabe, is using CGM to root out sneaky, seemingly healthy foods that can spike blood sugar and to prepare her body for starting a family.
- Edie Horstman was able to get her PCOS in remission and used a CGM to help create strategies for maintaining stable blood sugar and improve her sleep.
Practical Tips for Using CGM to Manage PCOS
To get a CGM in the United States, you’ll need a prescription from a doctor. In Europe and Canada, you do not. CGMs are traditionally used by people with diabetes. However, you can still ask your physician for a prescription, even if you do not have diabetes. You can also work with Levels or other companies.
With Levels, you’ll answer a questionnaire, which a licensed telehealth physician will review. If you’re eligible, the physician will write you a prescription for CGM. The prescription will be filled by a partnering pharmacy and shipped to your door. Your kit will come with instructions for getting started, such as how to apply the sensor and access your readings. Levels members can also get CGMs without a prescription by participating in our IRB-approved study, which looks to uncover glucose patterns in people without diabetes.
Once you start using your CGM, taking baby steps can be helpful. For example, for the first week, you may just want to practice getting readings and logging your meals and activities without changing your diet. This will give you a chance to see how the usual foods you eat and your usual lifestyle habits are affecting your glucose levels. Then in the second or third week, try implementing different strategies to reduce blood sugar spikes and to keep your blood sugar in the target range as much as possible. The Levels app will provide helpful feedback and insights.
Here are a few simple strategies for optimizing blood sugar control if you have PCOS:
- Dress your carbs. Pairing carbohydrates with healthy fats, protein, fiber, or a combination of these can help slow glucose absorption into your bloodstream. You may also want to experiment with eating the carbs on your plate last.
- Walk after a meal. Going for a walk after eating, ideally up to 30 minutes, can help blunt a blood sugar spike.
- Avoid ultra-processed foods. Stick to whole, nutrient-dense foods as much as possible. Ultra-processed foods are loaded with chemical additives, added sugar, sodium, and more. Their consumption is linked to insulin resistance. Additionally, many ultra-processed foods come in packaging that has endocrine-disrupting chemicals that could further exacerbate PCOS symptoms.
- Build muscle. Muscle tissue is more metabolically healthy than fat tissue. Resistance training improves blood sugar control and helps with body recomposition, which is a reduction in fat mass and an increase in muscle mass.
- Up your protein intake. Higher protein diets have been shown to reduce insulin resistance and insulin levels. Protein is also crucial for building and preserving muscle.
Conclusion
CGM can help people with PCOS monitor their glucose levels and develop nutrition and activity strategies for keeping their blood sugar more stable. In turn, more stable blood sugar could help increase insulin sensitivity and potentially reduce symptoms of PCOS, prevent the development of other chronic conditions like Type 2 diabetes, and help improve menstrual cycle function, which could have benefits for fertility.
More research is needed with clinical trials to show how CGM may be of benefit to people with PCOS, but clinical trials are in the works. Meanwhile, CGM is a non-medication, non-invasive tool that has shown promise in helping and empowering those with the condition.
