Weight that doesn’t seem to budge no matter what you do, endless fatigue, and never feeling full — sound familiar? If you are one of the 5-6 million women in the U.S. with PCOS, you know the challenge of managing these annoying symptoms.
However, many women living with PCOS have to manage an additional challenge that can come with its own set of problems: insulin resistance. So, what is insulin-resistant PCOS, and how can you manage it? Let’s dive in.
What is PCOS?
Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting an estimated 4-20% of women of reproductive age. No one knows exactly what causes PCOS, but genetics, excess androgens, obesity, and insulin resistance all play a role.
Insulin-resistant PCOS has a lot of the same symptoms as PCOS without insulin resistance, including:
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Irregular periods, or no periods at all
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Excess facial and body hair
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Oily skin and acne
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Fatigue
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Unexplained weight gain
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Patches of dark skin on the neck, armpits, groin, and under the breasts
While insulin-resistant PCOS can make it more difficult to get and stay pregnant and put you at a higher risk for developing type-2 diabetes in your lifetime, there are several ways to treat and manage symptoms so you can feel your best.
What is insulin resistance?
An estimated 65-70% of women with PCOS also have insulin resistance, which means their bodies have to create excess insulin to process glucose (sugar) in the blood. Over time, insulin resistance makes it difficult for the pancreas to function normally, which is why almost 50% of women with PCOS eventually develop type 2 diabetes.
The link between weight, PCOS, and insulin resistance is still being studied, but it is generally believed that the proteins (called cytokines) created by fat cells around the stomach increase insulin resistance. Excess androgens lead to weight gain around the stomach instead of around the hips, which creates a painful cycle of weight gain due to insulin resistance, which then makes insulin resistance worse. In our thin-obsessed society, this weight gain can also cause anxiety, adding to the challenge of PCOS.
How can you get tested for insulin-resistant PCOS?
If you are experiencing symptoms of insulin resistance, the first step is to talk to your doctor, who will likely take your medical history, order blood work, and conduct a physical exam. The physical exam might include measuring your blood pressure, measuring your waistline to see if it is above 35 inches, and checking your skin for skin tags and dark patches.
Blood tests are the most accurate way to diagnose insulin resistance. The most common tests are a fasting plasma glucose test to check your blood glucose and a hemoglobin glycosylated A1C to see your average blood glucose levels over several months.
If you are diagnosed with insulin resistance, your doctor will likely run these tests every 1-2 years to see if your symptoms have changed over time.
Can you reverse insulin resistance?
The good news is that insulin resistance can be managed and even reversed with both lifestyle changes and medication. With the right treatment, many people notice that they start to feel better within a few months. The right doctor will work with you to come up with a plan that works with your goals and lifestyle, which will likely include a combination of the following.
Exercise
In 2023, The American Diabetes Association updated its guidelines to recommend 150 minutes of moderate-intensity exercise like swimming, power walking, and Pilates per week, as well as 3 minutes of light movement, like stretching or walking, for every 30 minutes of sedentary activity.
Studies have found that it takes about 8 weeks of regular exercise to start to see improvements in insulin resistance, but some benefits, like lowered blood sugar, can be seen immediately following exercise.
Dietary changes
Nutrition plays a big part in managing insulin resistance symptoms, and a balanced diet can help you feel better and lose weight if that is your goal. Multiple studies have confirmed that reducing intake of simple sugars from soda, sweets, and fruit juices can help improve insulin resistance.
The relationship between low-carb diets and insulin resistance is still being studied, but a recent study in the Journal of Endocrine Society found that a very low-carb keto diet lowers androgen levels in women with PCOS within 45 days, and supports weight loss. Pretty Little Liars actress Sasha Pieterese cites the keto diet as a key change in managing her PCOS!
Medication
Finally, your doctor may suggest medications like metformin or supplements like myo-inositol and berberine as a treatment option, in addition to lifestyle interventions like diet and exercise.
Originally developed as a drug for type 2 diabetes, metformin decreases the amount of glucose in your blood and increases your body’s response to insulin. Metformin has been found to improve ovulation, reduce androgen levels, and promote weight loss in people with insulin-resistant PCOS. While it can come with some not-fun side effects, like nausea, gastrointestinal symptoms, and bloating, many find that these symptoms go away after a few weeks.
“Nature’s Ozempic” or not?
As for supplements, you might have seen TikToks touting the benefits of inositol and berberine for weight loss with insulin-resistant PCOS. But are they too good to be true? A 2022 study found that berberine has the potential to reduce the risk of cardiovascular disease, and myo-inositol appeared to improve insulin sensitivity in patients with PCOS. However, the study concluded that metformin was most effective at improving all health parameters in women with PCOS.
Whether it's medication, doctor-approved supplements, lifestyle changes, or all of the above, your healthcare team can help come up with the best treatment plan for your unique needs. Just know that there is hope, and research shows many promising options for managing insulin-resistant PCOS. Best of luck!
Erin Pettis is a content strategist, freelance writer, and women’s health advocate. She lives in New York City and holds an MBA from NYU’s Stern School of Business.