PCOS and insulin resistance: what’s the link?

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting many women of reproductive age. Characterised by symptoms like irregular menstrual cycles and elevated androgen levels, PCOS is further complicated by a significant metabolic component: insulin resistance.

Insulin resistance impacts both metabolic and reproductive health, so understanding its role in PCOS can lead to more effective treatments.

Understanding insulin resistance

Insulin resistance occurs when your body's cells don't respond well to insulin, a hormone that helps sugar enter your cells. This makes your blood sugar levels rise, causing your pancreas to pump out more insulin and lead to what's called hyperinsulinemia. Over time, this can lead to type 2 diabetes and other metabolic issues.¹ 

About 70% of women with PCOS have some level of insulin resistance, no matter their body weight.² This problem is complex and influenced by genetics, obesity, and hormonal imbalances, notably high androgen levels.³

Tackling insulin resistance in PCOS management

Addressing insulin resistance is key in handling PCOS, especially for those who are overweight or obese. Making lifestyle changes, like improving your diet and getting more exercise, are crucial steps for managing PCOS effectively. Research shows that these changes can significantly boost insulin sensitivity and lower androgens, leading to better reproductive health.⁴ Lifestyle adjustments not only target metabolic issues but also help in regulating menstrual cycles.²

On the medication front, metformin is a well-researched option* that improves insulin sensitivity and helps in regularising menstrual cycles.⁴ There's also some evidence suggesting vitamin D could enhance insulin sensitivity in women with PCOS, but more research is needed before making firm recommendations.⁵ Eating foods with a low glycemic index also seems to help manage insulin levels and improve metabolic health in women with PCOS.⁶

_{*Using medications outside of their licensing requirements or how they have been prescribed could be dangerous. This blog is for informational purposes only. Always ready the label and take all medication exactly as prescribed.}

GLP-1s: a promising addition to PCOS management

GLP-1s have shown substantial metabolic benefits, which may prove critical for managing PCOS, especially if these medications receive the appropriate authorisation* for treating PCOS.⁷

These benefits include significant reductions in BMI and waist circumference, improved insulin sensitivity, and increased levels of sex hormone-binding globulin (SHBG), which helps regulate androgen activity. Managing weight and insulin resistance could prove useful for improving overall health and fertility outcomes in women with PCOS.⁷

^{*Using medications outside of their licensing requirements or how they have been prescribed could be dangerous. This blog is for informational purposes only. Always ready the label and take all medication exactly as prescribed.}

The numan take

Insulin resistance plays a huge role in PCOS and affects both your body's metabolism and your reproductive health. Understanding how insulin resistance links with high androgen levels is essential for creating effective management plans. 

A well-rounded approach - combining lifestyle changes, medications, and diet tweaks - can reduce the impact of insulin resistance, ultimately leading to a better quality of life and improved long-term health for women with PCOS.

References:

1. Shirazi, F. K. H., Khodamoradi, Z., & Jeddi, M. (2021). Insulin resistance and high molecular weight adiponectin in obese and non-obese patients with Polycystic Ovarian Syndrome (PCOS). BMC Endocrine Disorders. https://doi.org/10.1186/s12902-021-00710-z

2. Moghetti, P., Tosi, F., Bonin, C., et al. (2013). Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/jc.2012-3908

3. Talaei, A., Adgi, Z., & Mohamadi Kelishadi, M. (2013). Idiopathic hirsutism and insulin resistance. International Journal of Endocrinology. https://doi.org/10.1155/2013/593197

4. Teede, H., Deeks, A., & Moran, L. J. (2010). Polycystic ovary syndrome: A complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Medicine.

5. Mohan, A., Haider, R., Fakhor, H., Hina, F., Kumar, V., Jawed, A., Majumder, K., Ayaz, A., Lal, P. M., Tejwaney, U., Ram, N., & Kazeem, S. (2023). Vitamin D and polycystic ovary syndrome (PCOS): A review. Annals of Medicine and Surgery, 85(7), 3506–3511. https://doi.org/10.1097/MS9.0000000000000879

6. Manta, A., Paschou, S. A., Isari, G., Mavroeidi, I., Kalantaridou, S., & Peppa, M. (2023). Glycemic index and glycemic load estimates in the dietary approach of polycystic ovary syndrome. Nutrients, 15(15), 3483. https://doi.org/10.3390/nu15153483

7. Meta-analysis on GLP-1 receptor agonists and PCOS outcomes. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-023-01500-5