Why Women With PCOS Have a Higher Risk of Diabetes

October 20, 2025

A doctor shows an x-ray image to a female patient

More than half of women with polycystic ovary syndrome (PCOS) develop type 2 diabetes by age 40, according to the Centers for Disease Control and Prevention.

“We’re always testing for diabetes in any patient who has PCOS, because we know they are higher risk,” says University Hospitals OB/GYN Archana Ayyar, MD, who specializes in reproductive endocrinology.

“There is a lot of support we can provide clinically to help patients navigate their diagnosis and help keep it under control,” she says. “There is association with increased anxiety and depression, so we need to make sure women have the support they need to manage this condition.”

What Is PCOS?

PCOS is a common hormonal disorder that often causes infertility and other health problems. With PCOS, the ovaries produce increased levels of androgens, which are male sex hormones.

PCOS symptoms often start in adolescence, with irregular menstrual cycles and possibly weight gain, says nurse practitioner Brandi Dobbs, CNP. The condition has a genetic link, but the cause is unknown.

Common symptoms may include:

Irregular menstrual cycles
Small, fluid-filled sacs called follicles on the ovaries
Abnormal hair growth
Oily skin / acne
Obesity
Insulin resistance
Thinning hair
Infertility

While the disorder is closely associated with being overweight, it’s not known whether weight gain causes PCOS or vice versa. “This isn’t something anyone asks to be born with, but a lot of patients feel frustrated, like they did something wrong,” says Dr. Ayyar. “There is such a negative stigma with weight in our culture. There is a lot of frustration with this, as patients with PCOS often have a more difficult time losing weight compared to overweight people without PCOS.”

“Sometimes patients can be very frustrated,” Dobbs says. “They’ve tried a multitude of diets, intense exercise regimens and weight-loss programs and they still have issues losing weight.”

The Health Risks of PCOS

In addition to weight gain and insulin resistance, which puts them at heightened risk for developing type 2 diabetes, women with PCOS are at higher risk of other health problems including:

Heart disease
Miscarriage
Pre-term births
Gestational diabetes
Preeclampsia
High blood pressure
High cholesterol
Sleep apnea
Endometrial cancer

Treating PCOS

Weight loss can go a long way to reduce the health risks of PCOS, Dobbs and Dr. Ayyar say.

Eating a healthy diet and exercise are always recommended. Dr. Ayyar counsels patients to avoid foods that raise insulin levels, like refined carbohydrates and sugary drinks. “Because patients have insulin resistance, you don’t want to consume any foods that spike your insulin, or you want to consume those foods in moderation.”

Dobbs recommends the Mediterranean diet for her patients, which features healthy fats, whole grains, beans, nuts, fruits and vegetables. “We talk about the Mediterranean approach a lot, and the healthy eating method from the American Diabetes Association, which is very similar.”

The program also focuses on exercise and weight-loss medications known as GLP-1 inhibitors, which can help with insulin resistance, Dobbs says. For overweight patients, losing as little as 5 to 10 percent of body weight can yield enormous benefits.

“Medication can really improve the menstrual cycle if a woman has irregular cycles, and allow her to ovulate again,” says Dr. Ayyar. “Diet and exercise also can improve symptoms, like excess hair growth, hair loss, acne and oily skin.”

Medications used to manage symptoms include metformin to lower insulin and blood sugar levels, and birth control to induce regular menstrual cycles and reduce androgen levels. GLP-1 inhibitors for weight loss can have a profound effect on PCOS symptoms.

“I think that’s going to be the future of treatment for patients with PCOS and obesity,” says Dr. Ayyar. “We are working with a lot of patients helping them to reduce their weight with GLP-1 medications.”