The link between insulin resistance and PCOS: understanding your metabolic health

Polycystic Ovary Syndrome (PCOS) affects up to 20% of women of reproductive age worldwide. While most recognize it for symptoms like irregular periods, acne, and excess hair growth, PCOS is much more than a reproductive disorder—it’s a complex metabolic condition with insulin resistance at its core.

Insulin is a hormone that allows your cells to absorb glucose from your bloodstream and convert it to energy. In insulin resistance, your cells don’t respond properly to insulin’s signals. Your pancreas compensates by producing more insulin, leading to higher-than-normal levels in your bloodstream—a condition called hyperinsulinemia.

This excess insulin creates a cascade of hormonal imbalances. It stimulates your ovaries to produce more androgens (male hormones) while decreasing sex hormone-binding globulin (SHBG), which normally binds excess testosterone. The combination worsens classic PCOS symptoms like irregular periods, acne, and excess hair growth. Insulin resistance also interferes with proper follicle development in the ovaries, contributing to infertility.

Research indicates that insulin resistance affects between 50-75% of women with PCOS, regardless of body weight, though it’s more prevalent and severe in those carrying excess weight.

Signs You Might Have Insulin Resistance with PCOS

Insulin resistance often develops silently, with no obvious symptoms in its early stages. As it progresses, you might notice dark, velvety patches of skin (acanthosis nigricans) typically on the neck, armpits, or groin; skin tags especially around the neck and armpits; central weight gain; and difficulty losing weight despite diet and exercise efforts.

Systemic symptoms may include fatigue, particularly after meals; increased hunger and food cravings for carbohydrates and sweets; brain fog; and frequent thirst. Metabolic markers might show elevated triglycerides, low HDL cholesterol, higher blood pressure, and prediabetes indicated by slightly elevated blood sugar.

Many women with insulin resistance don’t experience all these symptoms, and some may not notice any obvious signs at all. That’s why laboratory testing is essential for proper diagnosis.

How Insulin Resistance Worsens PCOS Symptoms

The relationship between insulin resistance and PCOS creates a vicious cycle. Elevated insulin stimulates more testosterone production, interfering with normal follicle development and ovulation. The excess testosterone causes facial hair growth, acne, and hair loss.

Insulin promotes fat retention, particularly around the abdomen. This type of central obesity further increases insulin resistance. Many women with PCOS report extreme difficulty losing weight despite significant efforts.

Insulin resistance contributes to ovulatory dysfunction, making conception more difficult. Even when pregnancy occurs, it increases the risk of complications including gestational diabetes and preeclampsia.

Without proper management, chronic insulin resistance can progress to type 2 diabetes and increase cardiovascular disease risk significantly.

How to Test for Insulin Resistance

If you have PCOS, testing for insulin resistance should be part of your regular health monitoring. Several tests can provide valuable information:

A fasting insulin test measures your insulin levels after an overnight fast. Elevated levels (above 10-12 μIU/mL) suggest insulin resistance, even when blood sugar appears normal. A glucose tolerance test with insulin measures both glucose and insulin levels after consuming a glucose solution.

HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) uses your fasting glucose and insulin levels to estimate insulin resistance. A value above 2.5 generally indicates insulin resistance. Hemoglobin A1C between 5.7-6.4% indicates prediabetes, which often accompanies insulin resistance.

Traditional glucose testing alone may miss insulin resistance in its early stages. Many women with PCOS have normal fasting glucose despite significant insulin resistance because their pancreas is compensating by producing extra insulin.

Managing Insulin Resistance Through Diet

A low-glycemic approach focuses on foods that have minimal impact on blood sugar levels. Emphasize non-starchy vegetables, protein sources, healthy fats, low-glycemic fruits, whole grains in moderation, and high-fiber foods. Minimize refined carbohydrates, sugary foods, sweetened beverages, processed foods, and starchy vegetables in large amounts.

Timing can be almost as important as what you eat. Eat at consistent times to regulate insulin and prevent extreme hunger. Include protein, healthy fat, and fiber with each meal to slow carbohydrate absorption. Consider starting meals by eating protein before carbohydrates to reduce post-meal insulin spikes.

The Role of Exercise in Improving Insulin Sensitivity

Exercise increases insulin sensitivity through multiple mechanisms. A single workout can improve insulin sensitivity for 24-48 hours. Regular exercise increases glucose transporters in your cells, reduces inflammation, and helps reduce visceral fat.

The most effective approach combines strength training to build and maintain muscle mass (2-3 sessions weekly); high-intensity interval training (HIIT) with short bursts of intense activity; moderate aerobic activity like walking or swimming (150 minutes weekly); and daily movement breaks throughout the day.

Medications and Supplements that Support Insulin Regulation

When lifestyle modifications aren’t sufficient, medications and supplements may help. Metformin improves insulin sensitivity primarily in the liver and may improve menstrual regularity, promote modest weight loss, reduce testosterone levels, and prevent diabetes progression.

GLP-1 receptor agonists like semaglutide were developed for diabetes but show promise for PCOS, potentially offering greater benefits than metformin alone for improving insulin sensitivity and weight management.

Inositol (particularly myo-inositol and D-chiro-inositol) works as an insulin sensitizer and can improve ovulation, menstrual regularity, and metabolic parameters. Other supportive supplements include berberine, magnesium, omega-3 fatty acids, vitamin D, and N-acetylcysteine (NAC).

Why Early Intervention Matters

Addressing insulin resistance early can prevent serious health complications. Without intervention, insulin resistance can progress to type 2 diabetes, with rates as high as 40% by age 40 in some studies of women with PCOS.

PCOS increases risk factors for heart disease like high blood pressure and unhealthy cholesterol profiles. Chronic insulin resistance may increase endometrial cancer risk. Addressing it can improve ovulation and fertility, potentially reducing the need for intensive fertility treatments later.

Understanding the central role of insulin resistance in PCOS shifts the approach from merely managing symptoms to addressing a root cause. By addressing insulin resistance consistently, you can significantly improve both current symptoms and long-term health outcomes.

If you’re struggling with PCOS symptoms, schedule a consultation with Heally today to create a personalized plan for addressing insulin resistance and improving your metabolic health.