Question of the Month

Q:  I have all the indicators for PCOS (Acne/Alopecia, abnormal hormonal levels, cysts, high cholesterol, abdominal weight gain) but I was given the 3 hour glucose/insulin test and was told that I did not have an insulin resistance problem, and therefore should not be medicated for it. But I wonder- is that necessarily true? Could the 'normal' insulin levels for most people be wrong for me? Should I ask to try an insulin level treating drug? I've been on hormonal treatment for a year now and other than clearing my skin a little and somewhat lessening my period pains it had not helped much.

A: You ask an important question. Lab tests need to be interpreted in the context of the individual's situation. Just looking at the so-called "reference range" on the lab report is not enough. Usually fasting insulin levels are said to be normal up to 22 or 27. However healthy young women generally have levels of 6 or less. Accordingly, I consider a level of 8 or higher to be suggestive of IR. Whether insulin sensitizers such as metformin (Glucophage) should be used depends not only on the insulin level but on other factors such as weight and menstrual pattern.

As to treatment not helping, I hear this all the time from women when I first see them for PCOS. Usually treatment must be directed at all the problems PCOSis causing an individual, not just one of them. Just to treat the skin problems, or just the IR, does not usually give adequate relief. The various treatment modalities are covered in detail on my web article on PCOS.

Hope this is helpful.

Geoffrey Redmond, MD

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