PCOS and Insulin Resistance

As a healthcare professional, I often see young women struggling with their weight, mood swings, and cycle irregularities without understanding the root cause. Understanding insulin resistance helps in managing PCOS more effectively.

PCOS is a hormonal condition where the ovaries produce higher-than-normal levels of androgens, which are male hormones. This imbalance affects ovulation and leads to the formation of multiple small cysts on the ovaries. Many women with PCOS do not ovulate regularly, leading to irregular or absent periods.

Key features include:

• Irregular menstrual cycles

• Excess facial or body hair

• Acne or oily skin

• Difficulty losing weight

• Hair thinning on the scalp

• Fertility problems

PCOS is not caused by a single factor. Genetics, lifestyle, diet, stress, and hormonal imbalance all play a role. In India, changing eating habits, reduced physical activity, and increased stress levels contribute to rising PCOS cases.

Insulin is a hormone made by the pancreas. Its main role is to help glucose from food enter the body’s cells to be used for energy. When the body becomes less responsive to insulin, more insulin is produced to keep blood sugar levels normal. This condition is called insulin resistance.

When insulin levels remain high for a long time, several changes occur in the body. Fat storage increases, especially around the abdomen. Hunger increases, leading to overeating and weight gain. Hormone production in the ovaries also changes, which worsens PCOS symptoms.

Most women with PCOS have some degree of insulin resistance, even if they are not overweight. High insulin levels stimulate the ovaries to produce more androgens. These excess hormones interfere with normal ovulation, leading to irregular periods.

Insulin resistance also increases the risk of:

• Weight gain, especially around the abdomen

• Increased appetite and sugar cravings

• Difficulty losing weight

• Darkening of the skin in body folds, known as acanthosis nigricans

• High cholesterol levels

• Type 2 diabetes

This cycle becomes self-perpetuating. PCOS worsens insulin resistance and insulin resistance worsens PCOS.

Some women are unaware they have insulin resistance because blood sugar levels may appear normal in early stages. Common signs include:

• Tiredness after meals

• Cravings for sweets or carbohydrates

• Weight gain despite normal eating

• Dark velvety patches on the neck, underarms, or groin

• Difficulty losing weight

• Frequent hunger

Recognizing these symptoms early helps in preventing long-term complications.

Diagnosis of PCOS is usually based on the Rotterdam criteria, which require any two of the following:

For insulin resistance, doctors may use tests such as:

• Fasting blood glucose

• Fasting insulin levels

• HbA1c

• Oral glucose tolerance test

• Lipid profile

A physical examination and complete medical history are also important. Early diagnosis is essential for long-term health.

If not managed properly, insulin resistance can lead to:

• Type 2 diabetes

• High blood pressure

• Heart disease

• Fatty liver disease

• Infertility

• Sleep apnea

• Metabolic syndrome

Women with PCOS should be monitored regularly for these conditions, especially if they have a family history of diabetes or obesity.

Managing PCOS with insulin resistance requires a combined approach. The goal is to improve insulin sensitivity, restore hormonal balance, and prevent complications.

Lifestyle Modifications

Lifestyle changes are the most effective and sustainable treatment. Even a 5 to 10 percent weight reduction can improve symptoms significantly.

Key recommendations include:

Balanced diet

A diet that stabilizes blood sugar helps control insulin levels. Focus on:

• Whole grains such as brown rice, millets, oats

• High-fiber vegetables

• Lean proteins such as legumes, eggs, and chicken

• Healthy fats from nuts and seeds

• Low glycemic index foods

Avoid refined carbohydrates, white bread, sweets, sugary drinks, and deep-fried foods.

Physical activity

At least 30 to 45 minutes of exercise daily improves insulin sensitivity. A combination of aerobic exercise and strength training works best. Walking, cycling, swimming, yoga, and resistance exercises are helpful and affordable.

Sleep and stress

Poor sleep and stress increase insulin resistance. Regular sleep routines, meditation, and relaxation techniques support hormonal balance.

Doctors may prescribe medications based on individual needs.

Metformin

Metformin improves insulin sensitivity and reduces glucose production in the liver. It also helps regulate menstrual cycles and supports weight loss.

Oral contraceptive pills

These help regulate cycles and reduce androgen levels.

Anti-androgen medications

Used to reduce excessive hair growth and acne.

Fertility medications

For women who wish to conceive, medicines like letrozole may be prescribed under supervision.

Treatment plans should always be personalized. A doctor should evaluate risks and benefits before prescribing medication.

Many Indian diets include high carbohydrate foods such as rice, chapati, and sweets. Small modifications can make a big difference.

Practical suggestions:

• Replace white rice with brown rice or millets

• Include salads before meals

• Reduce portion sizes of chapati and rice

• Use healthier cooking methods such as steaming and grilling

• Limit packaged foods and sugary tea

These changes are affordable and suitable for most households.

Medical help should be sought when:

• Periods are irregular for more than three months

• There are signs of high androgens

• Weight gain is rapid

• There are symptoms of high blood sugar

• Fertility concerns arise

Regular monitoring helps in early detection of complications.

PCOS and insulin resistance are closely linked and require a comprehensive approach to management. Understanding the role of insulin helps women make informed decisions about their health. Lifestyle changes, medical treatment when needed, and regular monitoring form the foundation of effective care. Early intervention improves symptoms, supports fertility, and reduces long-term risks. With awareness and consistent effort, women with PCOS can lead healthy and balanced lives.