How Insulin Resistance Impacts PCOS

February 7, 2024
Polycystic Ovary Syndrome on a notebook

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects as many as five million women of reproductive age.1 Common symptoms women with this condition may experience include the following:

  • irregular menstrual cycles
  • excessive hair growth on the face, chest, abdomen, and upper thighs
  • severe acne
  • acanthosis nigricans, which are patches of thickened, velvety, darkened skin
  • infertility

While the exact cause of PCOS is not fully understood, research has shown a strong association between PCOS and insulin resistance. Insulin resistance is a condition in which the pancreas makes insulin, but it is not used effectively.

As a result of insulin resistance and hormonal changes, women with PCOS have an increased risk of metabolic diseases, such as type 2 diabetes and obesity.

Understanding PCOS

PCOS is a complex hormonal condition that affects the ovaries and reproductive system. The syndrome is characterized by hormonal imbalances, specifically an increase in androgen (male hormone) levels, which can disrupt normal ovulation and lead to the formation of ovarian cysts.

PCOS is one of the leading causes of female infertility. Insulin resistance and other metabolic changes linked to PCOS raise a woman’s risk for the following conditions:

  • Abnormal blood lipids
  • Cardiovascular disease
  • Depression
  • Infertility 
  • Insulin resistance
  • Obesity
  • Sleep apnea
  • Type 2 diabetes mellitus
  • Uterine cancer

A PCOS diagnosis is made based on clinical findings. A PCOS diagnosis using the Rotterdam criteria requires having two of the following:2

  • Irregular menstrual cycles
  • Increased androgen levels
  • Polycystic ovaries

PCOS is a highly heritable medical condition that is frequently underdiagnosed. Lifestyle modifications can improve overall health and potentially decrease infertility by reducing insulin resistance.2

A women with bloating.

The Role of Androgens

Androgens are sex hormones that are produced in the ovaries and adrenal glands. Androgens are essential for4

  • Reproductive health
  • Heart health
  • Bone strength and density
  • Muscle tone and mass
  • Brain function

Hyperandrogenism occurs when androgen levels are higher than they should be.

PCOS and Insulin Resistance

Insulin resistance is a condition in which the body’s cells become less responsive to the effects of insulin, resulting in high blood sugar levels.

While insulin resistance is commonly associated with obesity and type 2 diabetes, research has shown a strong link between insulin resistance and PCOS. Most women with PCOS have at least some degree of insulin resistance, even those whose body weight falls within a healthy range.2 In one study (n = 254 women), 31% had impaired glucose tolerance, and 7.5% had undiagnosed diabetes.3

Insulin resistance is believed to play a significant role in the development and progression of PCOS. As body tissues develop insulin resistance, the pancreas initially compensates by producing more insulin.

High insulin and insulin-like growth factor 1 (IGF-1) levels increase the effect of luteinizing hormone (LH). LH stimulates the ovaries to produce androstenedione and testosterone. When these androgens increase, they contribute to hirsutism (unwanted hair growth), severe acne, and menstrual irregularities.

Hormonal imbalances and menstrual irregularities impact fertility. These metabolic changes can make it difficult for women with PCOS to conceive. They also increase the risk of gestational diabetes during pregnancy.

Increased androgens and insulin stimulate fat cell (adipocyte) production. Fat is not metabolized for energy as easily, which increases carbohydrate use and insulin resistance. When fat is not used for energy, it contributes to weight gain and obesity.

A woman measuring her waist circumference.

Increased androgen also affects fat distribution in women with PCOS. Increased androgens cause fat to be preferentially stored in the abdomen and around body organs.5

Increased androgens can also increase LDL (bad) cholesterol and fatty acids, which can increase the risk of cardiovascular disease.2

Insulin resistance is a key risk factor for developing metabolic complications, such as type 2 diabetes, cardiovascular disease, and dyslipidemia.

This sets up a feedback loop in which insulin resistance increases androgen levels, which increases abdominal adiposity, which increases insulin resistance.

Even though researchers understand the physiologic changes found in women with PCOS, their underlying cause is unknown.

Managing PCOS and Insulin Resistance

Women with PCOS who can effectively manage risk factors for insulin resistance can improve their symptoms, lower their risk of complications, and improve their overall health. Practical strategies for managing insulin resistance in PCOS include the following:

1. Weight Loss

Weight loss, if appropriate, can improve insulin sensitivity and reduce androgen levels. Studies suggest that losing 5% of body weight can ease PCOS symptoms and improve ovulation and fertility.6 However, insulin resistance can make weight loss challenging. High insulin levels promote fat storage and weight gain. Women with PCOS commonly have more cravings and hunger than people without the condition.

2. Physical Activity

Engaging in regular physical activity can improve insulin resistance and aid in weight loss. In one study, researchers reported that women with PCOS who performed progressive resistance exercise for four months were able to reduce their fasting glucose and androgen levels.7

Don’t overdo it on the exercise, as this can negatively affect ovulation and reproduction. Aim for about 30 minutes of exercise most days of the week.

Foods that can help PCOS and insulin resistance

3. Consume a Healthy Diet

A low-carbohydrate diet can lower insulin levels. Some experts recommend replacing carbohydrate calories with proteins because proteins can help stabilize your blood sugar, increase satiety, and reduce cravings.8,9,10

While a low-calorie diet is essential for weight loss, a low-glycemic index diet may be more effective in managing PCOS. The glycemic index is a classification system that ranks foods based on how much they raise blood sugar (glycemic response).

Typically, simple carbohydrates and highly processed foods such as cakes, white bread, and bakery products have a high glycemic index. Consume lean meats, whole grains, low-fat dairy products, non-starchy vegetables, and healthy sources of fat.

Conclusion

PCOS and insulin resistance are common and complex endocrine conditions. The complex interplay of insulin resistance, hormonal imbalances, and metabolic dysfunction all contribute to the characteristic symptoms of PCOS.

Diagnosing and treating PCOS and insulin resistance is critical for improving symptoms, promoting fertility, and lowering the risk of long-term complications.

Women with PCOS and insulin resistance can improve their overall health and well-being by making lifestyle changes, taking medications as needed, and focusing on weight loss.

If you have tried lifestyle modifications for managing PCOS and insulin resistance and continue to struggle with managing your weight, contact one of the treatment specialists at Invigor Medical to learn more about weight loss plans.

Get started today with a subscription for Lipo B12.

Frequently Asked Questions

How does insulin resistance affect PCOS?

Insulin resistance is a common feature in PCOS (Polycystic Ovary Syndrome) and can exacerbate its symptoms. Insulin resistance can lead to higher insulin levels, which may increase androgen production, causing some of the typical symptoms of PCOS, such as irregular menstrual cycles, acne, and hair growth.

What are the 4 stages of PCOS?

PCOS doesn’t have universally recognized “stages” like some other conditions. The symptoms and severity can vary widely from person to person. It’s generally recognized by a combination of symptoms such as irregular periods, hyperandrogenism (excess male hormones), and polycystic ovaries.

How to lose weight with insulin resistance PCOS?

To manage weight with insulin-resistant PCOS, a balanced diet low in refined carbohydrates and high in fiber can be effective. Regular exercise, particularly activities that increase insulin sensitivity like strength training, can also be helpful. It’s important to consult a healthcare provider for personalized advice.

Does insulin resistance cause fatigue in PCOS?

Yes, insulin resistance can contribute to fatigue in PCOS. Elevated insulin levels and the body’s struggle to use insulin efficiently can affect energy levels, potentially leading to feelings of tiredness or fatigue. Additionally, the hormonal imbalances in PCOS can also play a role in this fatigue.

Author: Leann Poston, M.D.
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Sources

  • Centers for Disease Control and Prevention. (2020) PCOS (Polycystic Ovary Syndrome) and Diabetes. Retrieved June 3, 2022, from: https://www.cdc.gov/diabetes/basics/pcos.html
  • Stepto N.K., Moreno-Asso A., McIlvenna L.C., Walters K.A., Rodgers R.J. (2019) Molecular Mechanisms of Insulin Resistance in Polycystic Ovary Syndrome: Unraveling the Conundrum in Skeletal Muscle? The Journal of Clinical Endocrinology & Metabolism. 104(11), 5372-5381. https://doi.org/10.1210/jc.2019-00167
  • Legro RS, Kunselman AR, Dodson WC, et al. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999;84:165–169.
  • Bianchi VE, Bresciani E, Meanti R, Rizzi L, Omeljaniuk RJ, Torsello A. The role of androgens in women's health and wellbeing. Pharmacol Res. 2021;171:105758. doi:10.1016/j.phrs.2021.105758
  • Tchernof A, Brochu D, Maltais-Payette I, et al. Androgens and the regulation of adiposity and body fat distribution in humans. Compr Physiol. 2018;8(4):1253-1290. doi:10.1002/cphy.c170009
  • Barber, T. M., Hanson, P., Weickert, M. O., & Franks, S. (2019). Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies. Clinical medicine insights. Reproductive health, 13, 1179558119874042. https://doi.org/10.1177/1179558119874042
  • Kogure, G. S., Miranda-Furtado, C. L., Silva, R. C., Melo, A. S., Ferriani, R. A., De Sá, M. F., & Dos Reis, R. M. (2016). Resistance Exercise Impacts Lean Muscle Mass in Women with Polycystic Ovary Syndrome. Medicine and science in sports and exercise, 48(4), 589–598. https://doi.org/10.1249/MSS.0000000000000822
  • Perelman, D., Coghlan, N., Lamendola, C., Carter, S., Abbasi, F., & McLaughlin, T. (2017). Substituting poly- and mono-unsaturated fat for dietary carbohydrate reduces hyperinsulinemia in women with polycystic ovary syndrome. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 33(4), 324–327. https://doi.org/10.1080/09513590.2016.1259407
  • Gower, B.A., Goss, A.M. (2015) A Lower-Carbohydrate, Higher-Fat Diet Reduces Abdominal and Intermuscular Fat and Increases Insulin Sensitivity in Adults at Risk of Type 2 Diabetes. The Journal of Nutrition, 145(1), 177S-183S. https://doi.org/10.3945/jn.114.195065
  • Sørensen, L. B., Søe, M., Halkier, K. H., Stigsby, B., & Astrup, A. (2012). Effects of increased dietary protein-to-carbohydrate ratios in women with polycystic ovary syndrome. The American journal of clinical nutrition, 95(1), 39–48. https://doi.org/10.3945/ajcn.111.020693
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