Polycystic Ovary Syndrome (PCOS) is a common health condition that affects how a woman’s ovaries work. About 10% of women of childbearing age suffer from PCOS, making it one of the most common hormonal disorders in this group. Many women with PCOS, between 35% and 80%, also deal with insulin resistance.

This means their bodies struggle to use insulin effectively, which can lead to high blood sugar levels. Insulin resistance is crucial to understand because it not only complicates PCOS but also increases the risk of developing diabetes and other health issues.

In this article, you will learn about the underlying mechanisms that connect insulin resistance with PCOS, how prevalent this issue is among women with PCOS, and what can be done to manage and potentially overcome these challenges.

Key Takeaways

  • Insulin resistance is a key factor in PCOS, worsening symptoms and increasing the risk of diabetes and heart disease.
  • PCOS is diagnosed based on symptoms like irregular periods, excessive hair growth, and ovarian cysts.
  • Up to 70% of women with PCOS have insulin resistance, making it a common issue among those with the condition.
  • Insulin resistance in PCOS can lead to weight gain, difficulty losing weight, and increased risk of type 2 diabetes.
  • Managing insulin resistance through lifestyle changes like a healthy diet and regular exercise can improve PCOS symptoms.
  • Medications such as metformin can help improve insulin sensitivity and manage PCOS more effectively.

What is Insulin Resistance?

Insulin resistance is a condition where the body’s cells don’t respond well to insulin, a hormone that helps convert sugar (glucose) from the food we eat into energy. Normally, insulin opens the doors that allow glucose to enter the cells. However, with insulin resistance, these doors don’t open easily, so glucose builds up in the blood instead of being used by cells.

This resistance affects the body’s ability to process glucose in several ways:

  • Increased blood sugar levels: Since glucose can’t enter cells, it accumulates in the bloodstream.
  • Overworked pancreas: The body tries to compensate by making more insulin, which can strain the pancreas.
  • Energy shortage in cells: Cells don’t get enough glucose, leaving you tired and weak.

Common symptoms and consequences of insulin resistance include:

  • Fatigue: Feeling unusually tired, despite resting.
  • Hunger: Persistent hunger, even after eating, due to cells not receiving glucose.
  • Weight gain: Particularly around the waist, as the body converts excess blood sugar into fat.
  • Darkened skin patches: Often seen on the neck, elbows, and knees.
  • High blood pressure: Stress on the body from insulin resistance can raise blood pressure.
  • High cholesterol: Imbalances in blood sugar can lead to elevated levels of bad cholesterol and triglycerides.

What is PCOS and How Is It Diagnosed?

PCOS is a hormonal disorder common among women of reproductive age. It involves a combination of symptoms that affect the ovaries and ovulation. The name “polycystic” refers to the many small cysts (fluid-filled sacs) that may form on the ovaries, although not every woman with PCOS has these cysts.

Diagnosis of PCOS follows the Rotterdam criteria, which require two of the following three features to be present:

  • Irregular Periods: Infrequent, irregular, or prolonged menstrual cycles are the most common signs of PCOS.
  • Excess Androgen Levels: High levels of male hormones may result in physical signs such as excess facial and body hair (hirsutism), severe acne, and male-pattern baldness.
  • Polycystic Ovaries: The ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.

To diagnose PCOS, doctors often use a combination of medical history, physical exam, blood tests to measure hormone levels, and ultrasounds to look at the ovaries.

Common Symptoms and Complications Associated with PCOS:

  • Weight gain or difficulty losing weight: Many women with PCOS are overweight or obese.
  • Fatigue: Many women with PCOS report increased fatigue and low energy.
  • Unwanted hair growth: Also known as hirsutism, about 70% of women with PCOS grow hair in areas where men typically have hair.
  • Thinning hair on the head: Hair might get thinner and fall out.
  • Acne or oily skin: Acne can be more severe because of higher levels of androgens.
  • Mood changes: Including depression and anxiety.
  • Headaches: Hormonal changes can cause headaches in some women.

Complications linked to PCOS include infertility, type 2 diabetes, obesity, heart disease, sleep apnea, and mood disorders. Managing PCOS usually involves treating symptoms, which can differ from one woman to another and may require lifestyle changes, medication, or both.

Why Does PCOS Cause Insulin Resistance?

Woman holding cardboard cutout of female reproductive system

The link between PCOS and insulin resistance is complex and influenced by various factors, including hormonal imbalances and genetic predispositions. One of the main reasons PCOS leads to insulin resistance lies in the relationship between hormones and how the body uses insulin.

Women with PCOS often have higher levels of androgens (male hormones), which are linked to insulin resistance. High androgen levels can impair the function of insulin in cells, making it harder for the body to use insulin effectively. This resistance causes the pancreas to produce more insulin to compensate, which can exacerbate the hormonal imbalance by increasing androgen production even further, creating a vicious cycle.

Additionally, research indicates that women with PCOS have a unique pattern of insulin resistance. Studies show that even when controlling for body weight, women with PCOS exhibit significantly higher levels of insulin resistance compared to women without the condition. This may be due to defects in insulin signaling pathways that are exacerbated by the hormonal environment of PCOS.

Genetic factors also play a crucial role. PCOS and insulin resistance both have strong genetic components, meaning the tendency to develop these conditions can be inherited. Certain genes may affect the way insulin receptors work on the cellular level or influence the production of insulin-degrading enzymes, impacting how the body responds to insulin.

How Common Is Insulin Resistance Among Women with PCOS?

Insulin resistance is very common among women with PCOS, affecting a large portion of this group. Another study shows that between 50% to 90% of women with PCOS have some level of insulin resistance, regardless of their weight. This high rate highlights the strong connection between PCOS and insulin issues, which is not just related to obesity—a common myth.

Research explores the complexities of insulin resistance in women with PCOS across different populations. The results show that insulin sensitivity varies widely among different ethnic and geographical groups. For example, South Asian women with PCOS often have higher rates of insulin resistance compared to Caucasian women. Additionally, the severity of insulin resistance in PCOS tends to be greater in populations with higher baseline rates of insulin problems, such as Hispanic and Middle Eastern communities.

What Are the Health Implications of Insulin Resistance in PCOS?

Insulin resistance significantly complicates the management of PCOS and heightens the risk of several serious health conditions. In PCOS, insulin resistance is not just a standalone issue but interacts with hormonal imbalances to exacerbate the symptoms of PCOS, such as irregular menstrual cycles, excessive hair growth, and infertility. The inability of insulin to function properly means that glucose levels can remain high, leading to chronic hyperglycemia which can disrupt hormonal regulation further.

Over time, chronic insulin resistance in women with PCOS can lead to more severe health issues. One of the most critical risks is the development of type 2 diabetes. Studies show that women with PCOS are at a significantly higher risk of developing diabetes compared to women without PCOS, due to their prolonged exposure to insulin resistance. Additionally, this insulin dysfunction can contribute to the development of cardiovascular diseases. The high levels of insulin and glucose can lead to an unfavorable lipid profile, increased arterial plaque build-up, and hypertension, all of which increase the risk of heart disease and stroke.

Furthermore, insulin resistance is associated with an increased risk of endometrial cancer. Persistent high levels of insulin and glucose can lead to excessive estrogen exposure, which can cause the endometrium, the lining of the uterus, to grow excessively, potentially leading to cancer.

How Can Insulin Resistance Be Managed in PCOS Patients?

Woman stretching with band

Managing insulin resistance effectively is crucial for women with PCOS and can greatly improve their quality of life and reduce the risk of developing further health complications. There are several strategies, both lifestyle-based and medicinal, that can help control insulin levels and enhance the body’s sensitivity to insulin.

Lifestyle Changes

  • Diet: Adopting a diet low in refined sugars and high in fiber can help manage insulin levels. Foods with a low glycemic index (such as whole grains, leafy greens, and most fruits) slow down the absorption of sugar, preventing spikes in blood glucose and insulin levels. Incorporating a balanced intake of protein and healthy fats can also stabilize blood sugar.
  • Exercise: Regular physical activity is one of the most effective ways to improve insulin sensitivity. Activities like aerobic exercise, strength training, and even daily walking can help muscle cells use glucose more efficiently. Regular exercise also helps manage weight, another important aspect of reducing insulin resistance.
  • Weight Management: Even a modest weight loss of 5% to 10% of total body weight can significantly improve PCOS symptoms and insulin sensitivity. Weight loss can be achieved through a combination of diet and exercise tailored to an individual’s preferences and needs.

Medication Options

  • Metformin: This is the most commonly prescribed medication for managing insulin resistance in PCOS patients. Metformin improves the body’s sensitivity to insulin and can help lower blood sugar levels, regulate menstrual cycles, and even aid in weight loss.
  • Thiazolidinediones: Drugs like pioglitazone can also enhance insulin sensitivity but are less commonly used than metformin due to potential side effects.
  • Incretin Mimetics: Medications such as liraglutide, which are typically used to treat type 2 diabetes, can also be effective in managing insulin resistance in PCOS. They work by increasing insulin secretion in response to meals and slowing down digestion, which helps control blood sugar levels.


Insulin resistance is a significant factor in PCOS, affecting many women diagnosed with this condition. The link between insulin resistance and PCOS is clear: insulin resistance exacerbates PCOS symptoms and increases the risk of other health issues like diabetes and heart disease. Understanding this connection helps in managing PCOS more effectively through lifestyle changes and medications aimed at improving insulin sensitivity. This approach not only alleviates PCOS symptoms but also reduces the risk of long-term health complications.

FAQs About Insulin Resistance And PCOS

How do I stop insulin resistance with PCOS?

To manage insulin resistance with PCOS, focus on lifestyle changes such as maintaining a healthy diet, engaging in regular physical activity, and managing stress. Incorporate whole grains, lean proteins, healthy fats, and fiber-rich vegetables into your diet. Aim for at least 30 minutes of moderate exercise most days of the week to improve insulin sensitivity.

What foods are good for insulin resistance PCOS?

Foods that are beneficial for managing insulin resistance in PCOS include:

  • High-fiber vegetables (broccoli, spinach, and cauliflower)
  • Lean proteins (chicken, fish, and tofu)
  • Whole grains (quinoa, brown rice, and oats)
  • Healthy fats (avocados, nuts, and olive oil)
  • Low-glycemic index fruits (berries, apples, and pears)

What is the best medication for insulin resistance PCOS?

Metformin is commonly prescribed to manage insulin resistance in PCOS. It helps improve insulin sensitivity and can also aid in weight loss and regulating menstrual cycles. However, the best medication can vary depending on individual needs and conditions.

What is the best exercise for insulin resistance PCOS?

The best exercises for insulin resistance in PCOS include a combination of aerobic exercises and strength training. Activities like walking, jogging, cycling, and swimming, along with resistance exercises such as weight lifting or bodyweight exercises, can significantly improve insulin sensitivity.

How do I know if I have insulin resistance in PCOS?

Insulin resistance in PCOS can be identified through symptoms such as weight gain, difficulty losing weight, fatigue, frequent hunger, and darkening of the skin (acanthosis nigricans). Blood tests measuring fasting insulin levels, glucose tolerance, and hemoglobin A1c can also indicate insulin resistance.

How do you fix insulin levels in PCOS?

To regulate insulin levels in PCOS, focus on a balanced diet low in refined sugars and high in fiber, regular physical activity, and weight management. Medications such as metformin can also help improve insulin sensitivity and regulate blood sugar levels.

Does fasting help with PCOS insulin resistance?

Intermittent fasting may help some individuals with PCOS by improving insulin sensitivity and promoting weight loss. However, it’s essential to approach fasting cautiously and ensure it fits your lifestyle and nutritional needs.

What is the root cause of PCOS insulin resistance?

The root cause of insulin resistance in PCOS is not entirely understood but is believed to involve a combination of genetic and environmental factors. Hormonal imbalances, particularly high levels of insulin and androgens, play a significant role in the development of insulin resistance in PCOS.

Can you get pregnant with insulin resistance PCOS?

Yes, it is possible to get pregnant with insulin resistance and PCOS. Managing insulin resistance through lifestyle changes, medications, and possibly fertility treatments can improve the chances of conception.

Can PCOS insulin resistance go away?

Insulin resistance in PCOS can be managed and significantly improved with lifestyle changes, medications, and weight loss. While it may not completely go away, effective management can reduce its impact and improve overall health.


National Center for Biotechnology Information. (2019). Lean polycystic ovary syndrome (PCOS): an evidence-based practical approach. PubMed Central. Retrieved June 15, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405408/

National Center for Biotechnology Information. (2022). The relationship between polycystic ovary syndrome and insulin resistance from 1983 to 2022: A bibliometric analysis. PubMed Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9366174/

National Center for Biotechnology Information. (n.d.). Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies. Retrieved June 15, 2024, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734597/