What’s The Link Between Insulin Resistance And PCOS?

Insulin resistance is the leading cause of type 2 diabetes, one of the most prevalent chronic diseases today. 

Insulin resistance is linked with other health issues, including some that impact hormone levels and fertility in women.

What exactly is the link between insulin resistance and polycystic ovary syndrome (PCOS)? Read on to learn more about this interesting connection.

What is insulin resistance?

Insulin is a hormone secreted by your pancreas, an organ between your stomach and spine. It helps glucose (sugar) move from your blood to your cells, where it’s used as energy. Insulin receptors are a type of receptor tyrosine kinase and help allow insulin to bind to the cell and allow sugar to enter.

A combination of a lack of insulin production and insulin resistance is what leads to type 2 diabetes and often polycystic ovary syndrome (PCOS).

Insulin resistance occurs when your body doesn’t respond to insulin the way it should, leading to high blood sugar levels. When your blood sugar levels are high, it stimulates your pancreas to produce more insulin to compensate for the elevated blood sugar. 

Over time, your pancreas can experience burnout from trying to produce enough insulin to keep your blood sugar levels at a healthy range.

People who are insulin resistant are often considered to have prediabetes, a condition where blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes. 

Insulin resistance is also common in women with PCOS. Left untreated, insulin resistance is the main cause of type 2 diabetes.

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What is PCOS?

Polycystic ovary syndrome, or PCOS, is a condition that impacts hormone levels in women. Most often, PCOS causes high levels of androgens, a type of male hormone. Testosterone is the most abundant male hormone and is often elevated in women with PCOS.

PCOS can impact girls as soon as they start their menstrual cycles. PCOS is one of the leading causes of infertility in women, so many women only learn they have PCOS once they start trying to start a family.

The typical age of onset of PCOS can be anywhere from age 12 (or the age at the time of menses), or it can develop into your twenties and thirties.

Elevated levels of androgens can lead to PCOS symptoms such as irregular periods due to lack of ovulation, cysts on the ovaries or enlarged ovaries, weight gain, oily skin, acne, unwanted hair growth (especially on the face), hair thinning, and infertility. 

PCOS is one of the most common causes of infertility, with an estimated prevalence rate of 6-12% of women of childbearing age. It can impact you regardless of your weight, though the majority of women with PCOS are considered overweight or obese.

PCOS is diagnosed if you meet at least two of three categories: high androgen levels (testosterone levels), lack of or absent ovulation, and cysts on your ovaries. PCOS is a syndrome, so diagnosing it isn’t as straightforward as other health conditions or diseases.

What is the link between insulin resistance and PCOS?

Most women with PCOS have insulin resistance, but some women with PCOS have normal insulin and blood sugar levels. It’s estimated that as many as 80% of women with PCOS are insulin resistant. If you have lean PCOS (meaning your BMI is considered ‘normal’), you’re less likely to have insulin resistance.

While its exact cause isn’t clear, there is a clear correlation between insulin resistance and PCOS. Insulin resistance can cause your ovaries to make more androgens, such as testosterone. High androgen levels disrupt the normal hormone balance needed to promote regular menstrual cycles, which can cause irregular periods and absent ovulation.

Insulin resistance and PCOS have genetic aspects, so you’re more likely to have them if you have a close family member that does. 

There are also known risk factors for insulin resistance, such as:

  • Obesity, especially carrying more of your weight around your abdomen (“apple shape”)
  • Inactive lifestyle
  • Diet high in carbohydrates, especially added sugar and refined carbohydrates
  • Gestational diabetes (diabetes during pregnancy)
  • Health conditions like nonalcoholic fatty liver disease 
  • A family history of diabetes
  • Smoking
  • Ethnicity (higher risk with African, Latino, or Native American ethnicities)
  • Being over the age of 45
  • Hormonal disorders like Cushing’s syndrome
  • Using steroids, antipsychotics, and HIV medications long-term
  • Sleep problems like sleep apnea

Signs of insulin resistance PCOS

You can have insulin resistance without any obvious signs, so it can be difficult to catch early on. Once you develop insulin resistance with PCOS, certain signs may develop, such as:

  • A waistline over 35 inches 
  • Blood pressure readings of 130/80 or higher
  • A fasting glucose level over 100 mg/dL
  • A fasting triglyceride level over 150 mg/dL
  • HDL cholesterol level under 40 mg/dL in men and 50 mg/dL in women
  • Skin tags
  • Patches of dark, velvety skin called acanthosis nigricans

Signs of high blood sugar can also signify that you have insulin resistance. Some symptoms of high blood sugar that can also indicate insulin resistance include:

Other PCOS symptoms that can develop with insulin resistant and non-insulin resistant PCOS include:

  • High androgen levels (hyperandrogenemia) – high levels of androgens such as testosterone and DHEAS can lead to symptoms like thinning hair, unwanted hair growth, acne, and oily skin. Acne along the jawline is especially common with excess androgen levels.
  • Irregular periods or very light periods
  • Lack of ovulation
  • Infertility – many women with PCOS need fertility treatment to aid in conceiving
  • Metabolic syndrome – excess weight gain in your belly, high blood sugar, high cholesterol, and high blood pressure are all aspects of metabolic syndrome
  • Depression
  • Anxiety
  • Pelvic pain

doctor

Treating insulin resistant PCOS

You can treat insulin-resistant PCOS with medications. The most common medication to treat PCOS is metformin, a popular type 2 diabetes drug.

Metformin helps treat insulin resistance by helping to sensitize cells to insulin. It also helps reduce the amount of sugar your liver releases. Metformin may help improve hormonal imbalances and regulate irregular menstrual cycles.

Metformin treatment has been shown to inhibit androgen production, which can help lessen some unwanted side effects of PCOS, like unwanted hair growth. Lowering testosterone levels can help achieve better hormonal balance helping to regulate menstrual cycles.

A study found that obese women lost weight due to metformin treatment. Weight loss can improve insulin sensitivity and improve PCOS symptoms.

The efficacy of metformin has been studied using a technique called a glucose clamp, which is a technique to assess insulin secretion. Studies using a glucose clamp conclude that metformin helps improve insulin sensitivity, which is the primary goal when treating insulin resistance.

Natural remedies and lifestyle changes for insulin resistance PCOS

Making healthy lifestyle changes is one of the best ways to combat insulin resistance. There are also natural supplements and vitamins that might help with your PCOS and insulin resistance symptoms.

Natural vitamins & supplements

Inositol

Some supplements might improve your PCOS symptoms by addressing insulin resistance. One of the most well-known supplements for PCOS is inositol.

Myo-inositol and D-chiro inositol are vitamin-like substances with insulin-mimetic properties, which means they act similar to insulin. Myo- and D-chiro inositol have been studied for their ability to improve insulin sensitivity and are often recommended for women suffering from PCOS to reduce symptoms.

Inositol has been studied in direct comparison with metformin in insulin-resistant women. Both metformin and myo-inositol had similar positive effects on insulin levels, fasting blood sugar, and hormone levels associated with PCOS. Improvements in insulin sensitivity and blood sugar levels might make weight loss a little easier to attain.

Magnesium

If you have PCOS, you’re more likely to be deficient in magnesium. Magnesium not only helps promote relaxation to help manage stress levels, but it might also play a role in insulin resistance and weight management.

Taking a magnesium supplement is a good way to ensure you’re getting enough on a regular basis. 

Berberine

Berberine is a compound found in plants that is often used as a natural PCOS treatment. It has been found to improve insulin sensitivity while also helping to reduce blood triglyceride levels and reduce waist circumference, which are some signs of insulin resistance. Berberine may also assist with weight loss.

A pilot study compared berberine and metformin directly for their potential to help treat type 2 diabetes. The researchers found that berberine produced identical results as metformin in terms of improving blood glucose metabolism. A1c, fasting blood sugar, postprandial blood sugar, and insulin levels all improved with the administration of berberine.

These results are promising if you’re suffering from insulin-resistant PCOS since improved blood sugar, insulin, and A1c levels indicate improved insulin sensitivity.

Lifestyle changes

Stress management

Women with PCOS tend to have an altered stress response, so they might not handle stress as easily. Chronic stress can worsen insulin resistance by raising cortisol levels, which can worsen insulin resistance.

While it can be easier said than done, try to practice stress management techniques that work for you. Talking therapy, deep breathing, exercise, and minimizing excessive time commitments are all good places to start. 

Cut back on added sugar

The average American adult consumes around 77 grams of added sugar per day, typically through processed foods and sugary drinks.

Added sugar raises your blood sugar levels quickly, which worsens insulin resistance. Eating high-sugar foods stimulate your body to produce a lot of insulin at once, which can tire your pancreas out and lead to insulin deficiency and diabetes.

The current Recommended Daily Allowance (RDA) for added sugar is 50 grams or less. The American Heart Association recommends that women don’t consume more than six teaspoons (24 grams) of added sugar per day, and men keep their added sugar intake below nine teaspoons (36 grams) per day. 

Lose weight sustainably

Losing 5-10% of your body weight is one of the best ways to improve insulin sensitivity. For example, if you weigh 200 pounds, a 20-pound weight loss (10%) will likely improve your insulin, blood sugar, and hormone levels.

RELATED: How to Lose Weight with PCOS.

Conclusion

Many women with PCOS also have insulin resistance, which worsens hormonal imbalances. Targeting insulin-resistant PCOS is similar to treating type 2 diabetes in terms of lifestyle and medication management.

Explore More

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PCOS Diet: Foods To Eat And Foods You Should Avoid.

Sources

  1. Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance?. Fertil Steril. 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277302/ 
  2. Hirsch A, Hahn D, Kempná P, Hofer G, Nuoffer JM, Mullis PE, Flück CE. Metformin inhibits human androgen production by regulating steroidogenic enzymes HSD3B2 and CYP17A1 and complex I activity of the respiratory chain. Endocrinology. 2012. https://pubmed.ncbi.nlm.nih.gov/22778212/ 
  3. Harborne LR, Sattar N, Norman JE, Fleming R. Metformin and weight loss in obese women with polycystic ovary syndrome: comparison of doses. J Clin Endocrinol Metab. 2005. https://pubmed.ncbi.nlm.nih.gov/15886247/ 
  4. Widén EI, Eriksson JG, Groop LC. Metformin normalizes nonoxidative glucose metabolism in insulin-resistant normoglycemic first-degree relatives of patients with NIDDM. Diabetes. 1992. https://pubmed.ncbi.nlm.nih.gov/1551495/ 
  5. Nas K, Tűű L. A comparative study between myo-inositol and metformin in the treatment of insulin-resistant women. Eur Rev Med Pharmacol Sci. 2017. https://pubmed.ncbi.nlm.nih.gov/28724173/
  6. Hamilton KP, Zelig R, Parker AR, Haggag A. Insulin Resistance and Serum Magnesium Concentrations among Women with Polycystic Ovary Syndrome. Curr Dev Nutr. 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822014/ 
  7. Pérez-Rubio KG, González-Ortiz M, Martínez-Abundis E, Robles-Cervantes JA, Espinel-Bermúdez MC. Effect of berberine administration on metabolic syndrome, insulin sensitivity, and insulin secretion. Metab Syndr Relat Disord. 2013. https://pubmed.ncbi.nlm.nih.gov/23808999/ 
  8. Yin J, Xing H, Ye J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism. 2008. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2410097/
  9. Benson S, Arck PC, Tan S, Hahn S, Mann K, Rifaie N, Janssen OE, Schedlowski M, Elsenbruch S. Disturbed stress responses in women with polycystic ovary syndrome. Psychoneuroendocrinology. 2009. https://pubmed.ncbi.nlm.nih.gov/19150179/

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