Written by Ali Long:  Ali is an intern at BNC, an undergraduate psychology student, and will be graduating in 2024! She plans to one day pursue a career as a registered dietitian where she can help women find the root cause of their hormone-related health issues. Her approach centers on utilizing nutrition as a powerful tool to alleviate physical and psychological symptoms, which is why she is specifically interested in the holistic approach to health. On her days off from school, she enjoys pilates, weightlifting, traveling, cooking, baking, and experimenting with different types of coffee!

Edited and revised by Emily Cafarella: Click here to read her bio and learn more about her!

Do you often find yourself caught in the web of conflicting information when it comes to managing insulin resistance in Polycystic Ovary Syndrome (PCOS)?

The world of health advice can be a labyrinth, especially when a simple Google search yields an overwhelming array of opinions and so-called ‘experts’, each claiming to be the ultimate solution.

Navigating through this maze can leave you more perplexed than enlightened. In an age where information is at our fingertips, it's tempting to rely on the vast virtual realm for guidance.

Today, as a team of registered dietitians and health professionals, we embark on a journey to cut through the noise, dispel common misconceptions, and empower you with actionable tips for conquering insulin resistance in PCOS.

So, let's set aside the confusion, ditch the unreliable results of a random online search, and delve into evidence-based insights that can make a tangible difference in your journey towards conquering PCOS-related insulin resistance.

PCOS and Insulin Resistance

First, let’s start off with what PCOS and insulin resistance are, and why they often go hand in hand.

Polycystic ovary syndrome (PCOS) is a complex reproductive endocrine disorder. It is the main contributor to anovulatory infertility challenges (11).

Although exactly what predisposes women to developing PCOS is unknown, we do know that insulin resistance and inflammation contribute to the severity of PCOS symptoms.

Insulin resistance occurs in approximately 70% of women with PCOS so it is important to understand how to manage and reverse it if you are one of those women. To learn more about signs and symptoms of PCOS, check out our previous blog post here.

So first, let’s talk about insulin.  

What is Insulin & Insulin Resistance

Insulin is an important hormone that helps us to store energy. It helps us move nutrients (like carbs & protein) out of our bloodstream, and into our cells for immediate use or storage.

However, issues arise when our cells are exposed to constant high amounts of insulin. This can cause our cells to become resistant to it. High levels of insulin is caused by high sugar intake, excessive carbohydrate consumption, overeating protein, stress, and more.

When the body cannot appropriately respond to insulin, it is not able to uptake sugar (glucose) into the cells to make energy. To compensate for this struggle, the cells that produce insulin work harder. This leads to high levels of insulin in the blood, known as hyperinsulinemia (3).

We often see insulin resistance in PCOS because of the imbalanced sex hormones, which in turn makes it difficult to respond to insulin.

While it might feel intimidating at first, learning to manage your insulin resistance will be the most effective way to improve your PCOS symptoms and restore ovulation.

Hormone Imbalances in PCOS and Insulin Resistance

As previously mentioned, PCOS is an endocrine disorder and symptoms are a result of imbalanced hormones. There are three hormones involved in insulin resistance PCOS:

• Androgens

• Progesterone

• Insulin

Androgens are often referred to as the “male sex hormone”. These hormones promote and maintain masculine characteristics in reproductive tissues (5). Although they are referred to as the male sex hormone, women produce them too. For women, they are essential for ovarian function, muscle mass, bone health, sexual function, mood, and more!

Progesterone is a natural hormone made by the adrenal cortex, ovaries, and testes (1). This hormone plays a large role during a woman's menstrual cycle and is prominent during the luteal phase. It also is responsible for assisting in the early stages of pregnancy.

Insulin is a hormone made by the pancreas (10). Its main purpose is to control blood sugar levels. It ensures that cells receive the necessary energy for their functions while preventing excessive glucose accumulation in the bloodstream.

In insulin resistance PCOS, these hormones are not balanced as they should be. Since insulin influences the production of androgens, when there is an increased level of insulin, this leads to elevated levels of androgens.

When androgen levels are too high, it can contribute to lower progesterone levels. This makes it more difficult to maintain a pregnancy, contributing to infertility.

WOW! So that was a lot of information. While it is not a necessity that you understand every detail of your body’s hormonal mechanisms, it can definitely be helpful to have some background information. Don’t worry, no need to memorize every little thing, let’s dive into the symptoms that are often associated with hormonal imbalances.

Symptoms

Symptoms of insulin resistance in PCOS includes (9):

• Irregular menstrual periods

• Hirsutism (Excess hair growth)

• Acne

• Weight gain or difficulty losing weight

• Infertility

• Fatigue

These symptoms are generally due to the high levels of androgens in PCOS.

When it comes to insulin resistance PCOS, there are additional symptoms associated with it. This is due to the excess insulin.

If you notice these symptoms, especially with PCOS, you may have insulin resistance PCOS.

These may include (4):

• Sweet and salty food cravings

• Skin darkening in the groin, armpits, or the nape of the neck.

• Tingling feeling in the hands of feet

• Overwhelming tiredness or exhaustion

• Urinating frequently or experiencing an increase in urination

• Heightened appetite or increased thirst

If you are noticing any of these symptoms, please consult your health care provider for further evaluation.

How is PCOS Diagnosed?

Healthcare professionals will often diagnose PCOS under specific conditions.

The criteria for diagnosing PCOS is based on the Rotterdam Criteria. This criteria states that women must meet 2 of the 3 following criteria:

• Presence of ovarian cysts, fluid-filled sacs located the ovaries

• Clinical Hyperandrogenism (hirsutism) and/or signs of elevated androgen or testosterone levels.

  • This can be confirmed through blood tests or by assessing symptoms like facial hair and hormonal acne associated with excess androgens.

• Irregular or no menstrual cycle

If you are only presenting one of these symptoms, it may not be PCOS. Rather, it may be a condition called hypothalamic amenorrhea, which is often misdiagnosed for PCOS because the symptoms are similar.

To learn more about HA, click here to download our FREE guide all about HA and if you lost your period.

If you are looking for a more in-depth look at HA or other health-related fertility issues, you can enroll in our online program Hormone Academy!

After being diagnosed with PCOS, you may be wondering what to do next. One thing you can do is watch out for other symptoms of insulin resistance PCOS.

How is Insulin Resistance in PCOS Diagnosed?

If diagnosed with PCOS, pay attention to symptoms possibly associated with insulin resistance. If you are experiencing these symptoms, you may want to check your fasting glucose/insulin ratio.

There are a few ways you can get tested for this.

This includes:

• Fasting Glucose: Blood draw which measures blood glucose levels after an overnight fast

• Fasting Insulin: Blood draw which measures insulin levels in the blood after an overnight fast

• Oral Glucose Tolerance Test (OGTT): Involves drinking a glucose solution followed by multiple incremental blood draws measuring your blood glucose levels at set periods of time.

Always consult your health care provider in order to determine the best option for you.

If your test results indicate insulin resistance, do not be discouraged! There are many ways to alleviate symptoms and effectively manage the condition through lifestyle changes.

Lifestyle Modifications

In insulin resistant PCOS, there are many ways to effectively manage symptoms using lifestyle changes. Some of the primary ways include:

• Diet and nutrition

• Regular exercise

• Stress management

When making these modifications, give yourself time to transition. In other words, don’t try to make all these changes at once.

Making each of these changes at once may cause additional stress on your body. Allow yourself to slowly incorporate each modification for a sustainable lifestyle!

Now, let’s look at how to implement these modifications!

#1 Balance Your Diet

First, diet and nutrition play a significant role in overall health. In insulin resistant PCOS, it is even more vital to ensure your body is receiving adequate nutrition.

More specifically a balanced diet is especially important in PCOS. Balanced plates offer many benefits in general.

This includes:

• Promotes satisfaction between meals

• Balances blood sugars

• Supports metabolism

So, what is a balanced plate? No matter what type of PCOS, it's essential to prioritize a diverse and nutrient-rich diet.

Having a balanced plate does not necessarily have equal amounts of everything. Rather, it means choosing diverse foods that provide your body with the right amount of nutrients it needs to thrive.

Typically, you want to ensure you have sources of protein, carbohydrates, fiber, and healthy fat in every meal.

To learn more about how to manage insulin resistant PCOS using nutrition, schedule a FREE 1:1 consult with a registered dietitian here!

Although it can be overwhelming trying to figure out how to balance your plate, it can be beneficial to have the support of a registered dietitian to assist you and your nutritional needs.

#2 Regularly Exercise

In addition to diet and nutrition, regular exercise can alleviate some symptoms.

This is considering that it can assist in:

• Improving insulin sensitivity

• Weight management

• Hormonal balance

• Reducing cardiovascular risk

• Improving mood

• Reducing stress

There is no specific type of exercise that is more beneficial for PCOS. Rather, it is simply just important to move your body regularly in a way that feels good for YOU.

Some ideas for movement include (7):

• Aerobic exercises (e.g. walking, bicycling, or dancing)

• Weight lifting

• Mind-body exercises (e.g. yoga, Pilates, or tai chi)

In every activity, make sure to prioritize both movement and self-care for your body. This means ensuring that you are providing your body with the nutrients it needs and not overexerting your body. Neglecting this can lead to added stress on your body, resulting in adverse effects.

#3 Manage Stress

Lastly, stress management is a lifestyle change you can make to manage PCOS symptoms.

In addition to the physical manifestations related to PCOS, there are also psychological impacts of PCOS. The most prevalent mental health consequence is depression, occurring at a rate eight times higher than average in women with PCOS (2).

High amounts of stress can definitely contribute to the physiological symptoms that occur in PCOS. I hear you right now…. what!? My mental state impacts how my body literally feels?! Yes, that’s right! Increased stress levels can actually lead to increased physical symptoms of feeling unwell. Stress management can assist in alleviating these symptoms.

Stress management strategies include:

• Practicing healthy coping skills

• Meditation

• Adequate sleep

• Social support

• Counseling or therapy (e.g. cognitive behavioral therapy)

• Physical activity

Overall, making these lifestyle modifications can be vital in improving symptoms of insulin resistant PCOS.

Summary

Living a happy and healthy life with PCOS is possible, despite the absence of a cure. The hormonal imbalances in insulin resistance PCOS can cause many negative implications. However, there are tips and tricks you can use to promote a sustainable, healthy, and happy lifestyle in the long run.

Balancing your diet, maintaining regular exercise, and managing stress are the biggest ways to support your body.

Implementing these changes gradually allows for a sustainable and holistic approach to managing insulin resistant PCOS. This will promote overall physical and mental health.

So what now? Take these tips and utilize them to make a positive change in your life!

You are the biggest advocate for your body. Making these changes can help you feel confident in managing your health!

References:

1- Cable, J. K., & Grider, M. H. (2023). Physiology, Progesterone. In StatPearls. StatPearls Publishing.

2- Ethirajulu, A., Alkasabera, A., Onyali, C. B., Anim-Koranteng, C., Shah, H. E., Bhawnani, N., & Mostafa, J. A. (2021). Insulin Resistance, Hyperandrogenism, and Its Associated Symptoms Are the Precipitating Factors for Depression in Women With Polycystic Ovarian Syndrome. Cureus, 13(9), e18013. https://doi.org/10.7759/cureus.18013

3- Freeman, A. M., Acevedo, L. A., & Pennings, N. (2023). Insulin Resistance. In StatPearls. StatPearls Publishing.

4- Galan, N. (2022). Diagnosing Insulin Resistance in Women With PCOS. Verywell Health. Retrieved December 27, 2023, from https://www.verywellhealth.com/how-do-i-know-if-i-have-insulin-resistance-2616646

5- Handelsman, D. J. (2020, October 5). Androgen Physiology, Pharmacology, Use and Misuse - Endotext. National Center for Biotechnology Information. Retrieved December 21, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK279000/

6- Kallen, A. (2023). Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, and Treatment. Healthline. Retrieved December 27, 2023, from https://www.healthline.com/health/polycystic-ovary-disease#causes

7- Kallen, A. (2020). Exercise For PCOS: Sample Plan, Types of Exercise, and More. Healthline. Retrieved December 28, 2023, from https://www.healthline.com/health/womens-health/exercise-for-pcos

8- Legro, R. S., Castracane, V. D., & Kauffman, R. P. (2004). Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstetrical & gynecological survey, 59(2), 141–154. https://doi.org/10.1097/01.OGX.0000109523.25076.E2

9- Purwar, A., & Nagpure, S. (2022). Insulin Resistance in Polycystic Ovarian Syndrome. Cureus, 14(10), e30351. https://doi.org/10.7759/cureus.30351

10- Rahman, M. S., Hossain, K. S., Das, S., Kundu, S., Adegoke, E. O., Rahman, M. A., Hannan, M. A., Uddin, M. J., & Pang, M. G. (2021). Role of Insulin in Health and Disease: An Update. International journal of molecular sciences, 22(12), 6403. https://doi.org/10.3390/ijms22126403

11- Sadeghi, H. M., Adeli, I., Calina, D., Docea, A. O., Mousavi, T., Daniali, M., Nikfar, S., Tsatsakis, A., & Abdollahi, M. (2022). Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Repurposing. International journal of molecular sciences, 23(2), 583. https://doi.org/10.3390/ijms23020583