PCOS and Insulin Resistance: What's the link?

Between 50-95% of women with PCOS have insulin resistance (1), which is believed to be the driving force for most of the signs and symptoms of the syndrome.

In this blog post I’m going to break down what insulin and insulin resistance are, explore the link between PCOS and insulin resistance, and provide you with some guidance on how to keep your insulin levels well-managed with diet and lifestyle.

What is insulin?

Insulin is a hormone that is produced by an organ in your body called the pancreas.

Carbohydrate rich foods such as bread, pasta, rice, potatoes, pulses, fruits, as well as foods such as soft drinks, fruit juice, pastries and cakes all break down into glucose and cause your blood glucose levels (often referred to as blood sugar levels) to rise.

Once this glucose enters your bloodstream, insulin is released to help the glucose move out of your blood into your body's cells for energy. Like a lock and key mechanism, most of the cells in your body have special 'locks' or receptors for insulin. If you think of insulin as the key, and has attached itself into the 'lock' of the cell, it opens and allows glucose to flow into the cell.

What is insulin resistance?

If the 'lock' or receptor of the cell is defective in some way then the cell is said to be 'insulin resistant', and they block the uptake of insulin into the cells. Your pancreas then responds by releasing more insulin to try and fix this block to allow glucose to be transported. High insulin levels can contribute to various health issues, including type 2 diabetes and cardiovascular disease (2).

The Link Between PCOS and Insulin Resistance

As mentioned above, insulin resistance is found in 50-95% of women with PCOS, making it one of the most prevalent features and the driving force of the syndrome. Having too much insulin in your blood, can affect your reproductive hormones and can lead to a range of hormonal imbalances that create symptoms of PCOS.

Symptoms of Insulin Resistance and PCOS

• Irregular or no periods: High insulin levels stimulate the ovaries to produce more androgens (male hormones) such as testosterone. This excess testosterone can interfere with normal ovulation, leading to irregular periods or no periods at all, which can make it difficult to become pregnant (3).

• Increased appetite and weight gain: High insulin can stimulate your appetite, increase cravings, and can cause your body to store fat, particularly around your stomach. This creates a vicious cycle because increased body fat can worsen insulin resistance, and can increase symptoms of PCOS, including high cholesterol levels.

• Hair and skin concerns: High testosterone levels may cause physical signs such as excess facial or body hair, hair loss/thinning, increased sebum (oil) production, acne, skin tags, and dark patches on the skin (acanthosis nigricans).

  
  

• Fatigue: High levels of insulin and constantly fluctuating blood sugar levels can cause fatigue.

How do you know if you have insulin resistance?

If you’re experiencing any of the symptoms of insulin resistance, it’s important to speak with your doctor. Tests such as fasting plasma glucose and HbA1C only measure your blood sugar levels, they don't measure how much insulin is in your blood. However, a fasting insulin blood test and an oral glucose tolerance test (OGTT) can help measure the amount of insulin in your blood.

How can diet manage insulin levels?

The good news is that making positive changes to your diet and lifestyle can successfully manage your insulin resistance and your PCOS symptoms.

Here are my top six steps to help you get started:

• Establish a regular eating pattern: To keep blood sugar levels stable, aim to eat every 3-4 hours. Avoid skipping meals or going for long periods without eating. This can increase your risk of overeating at your next meal and can cause your body to produce large amounts of insulin very quickly.

  
  

• Choose low GI foods. These types of foods you can control your blood glucose and reduce insulin resistance (4). You can read more about these in my previous blog post here.

• Practice regular movement. Daily movement makes your muscles more sensitive to insulin, which helps to control blood sugar levels.

• Maintain a healthy sleep cycle. Insufficient sleep can increase your stress hormones, causing low energy, low mood, and food cravings.

• Consider supplements. Research has shown some dietary supplements to be effective at improving insulin sensitivity. These depend on your individual requirements, and you can discuss these with your GP/dietitian.

• Seek support. Working in partnership with your GP/dietitian or other health professionals can ensure that you’re on the best PCOS management plan. You might also want to speak with your family, friends and support groups to help you feel more supported.

Key takeaways

Insulin resistance is common in women with PCOS. Managing insulin resistance is not just about alleviating the symptoms of PCOS—it’s also about preventing serious long-term health conditions such as type 2 diabetes and cardiovascular disease. By understanding the relationship between PCOS and insulin resistance, you can can better navigate your health journey, make informed decisions about your care, and reduce symptoms and your risk of long-term complications.

If you're looking for some personalised support and guidance to support managing your insulin resistance and improving your PCOS symptoms, book your FREE 20-minute Discovery Call here.

References

1. D Mukherjee (2024). Polycystic Ovary Syndrome, Insulin Resistance, and Cardiovascular Disease: Ischemic Heart Disease.Current Cardiology Reports, 26, 483–495.

2. Moran, L. J., Misso, M. L., Wild, R. A., & Norman, R. J. (2010). Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Human Reproduction Update, 16(4), 347-363.

3. Farrell, M.S & Antoni, M (2010). Insulin Resistance, Obesity, Inflammation, and Depression in Polycystic Ovary Syndrome: Biobehavioral Mechanism and Interventions. Fertility & Sterility, 94(5), 1565–1574.

4. Marsh, K. A., Steinbeck, K. S., Atkinson, F. S., Petocz, P., & Brand-Miller, J. C. (2010). Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. The American Journal of Clinical Nutrition, 92(1), 83-92.