PCOS Living With The Link Between PCOS and Insulin Resistance By Nicole Galan, RN facebook twitter linkedin Nicole Galan, RN, is a registered nurse and the author of "The Everything Fertility Book." Learn about our editorial process Nicole Galan, RN Medically reviewed by Medically reviewed by Anita Sadaty, MD on November 25, 2020 facebook twitter linkedin instagram Anita Sadaty, MD, is a board-certified obstetrician-gynecologist at North Shore University Hospital and founder of Redefining Health Medical. Learn about our Medical Review Board Anita Sadaty, MD on November 25, 2020 Print Table of Contents View All Table of Contents Conditions Connection Symptoms Screening As many as 30% to 40% of women who have polycystic ovary syndrome (PCOS) also have insulin resistance — a condition that leads to high glucose levels and the potential for pre-diabetes and type 2 diabetes. In fact, insulin resistance may actually be at the root of one's PCOS, playing a role in causing the condition in the first place, as well as exacerbating its symptoms. Insulin resistance requires management with lifestyle modifications or treatment with medication to prevent complications, so it's something every woman with PCOS should be screened for. Thomas Barwick / Getty Images The Conditions PCOS is a hormonal condition that can cause irregular menstrual cycles, fertility difficulties, excess male hormone levels, and small follicles on the ovaries. The pancreas, a gland in the abdomen with a number of functions, produces insulin. Insulin is typically secreted in response to increased blood levels of glucose, a small sugar molecule. When we eat carbohydrates, the glucose molecules enter into our blood within about 15 minutes. Insulin allows cells throughout the body to take in the glucose, which is later used for energy. When someone has insulin resistance, the body does not respond to insulin as efficiently or as quickly as it should, leading to high glucose levels in the blood, low energy, or both. With time, larger and larger amounts of insulin are required before glucose is taken into the body tissues. Eventually, the body begins to deal differently with sugar. Consistently high levels of glucose in the blood can lead to pre-diabetes, and then, to diabetes. The Connection PCOS is recognized as a risk factor for developing diabetes. Despite the fact that the signs and symptoms of PCOS begin before the signs and symptoms of insulin resistance, it is believed that insulin resistance may play a role in causing PCOS, rather than the other way around. Elevated insulin levels may be a contributing factor to inflammation and other metabolic complications associated with PCOS. While the connection is known, the causes of the relationship between the two conditions are not completely clear. Most importantly, insulin resistance does not affect everyone in exactly the same way, and some women with insulin resistance develop PCOS, while others do not. Some experts suggest that obesity-associated insulin resistance alters the function of the hypothalamus and the pituitary gland in the brain, increasing the production of androgenic hormones, which contribute to PCOS. Excessive production of androgenic hormones is an independent risk factor for female infertility and ovarian dysfunction, with or without PCOS. While each condition is associated with depression, the risk of depression is much stronger when the two conditions occur together. Similarly, insulin resistance and PCOS each contribute to infertility. The hormonal changes of PCOS interfere with proper implantation of the embryo, while insulin resistance can lead to miscarriage due to inadequate nutrition and support of the growing embryo. When PCOS and insulin resistance are combined, infertility and early miscarriage can make it difficult to carry a baby to term. If you have insulin resistance or PCOS, you are also at risk of developing gestational diabetes during pregnancy. Symptoms Symptoms of insulin resistance are similar in women who have PCOS and those who don't. It is important for women with PCOS to be aware of these symptoms because of the strong correlation between the two conditions. Changes in Appetite Insulin is an appetite stimulant, which is perhaps why many women with PCOS report frequent cravings for sweets and other carbohydrate-rich foods. This leads to weight gain, which increases the risk of health problems such as cardiovascular disease, obesity, osteoarthritis, and diabetes. Pre-Diabetes or Diabetes Pre-diabetes increases the risk of type 2 diabetes and other metabolic conditions. During this stage, which can last as long as 10 to 12 years, the body is not optimally sensitive to insulin. This leads to high blood sugar levels for a prolonged time after eating. Symptoms include decreased energy, increased thirst, and frequent urination. Diabetes can cause decreased energy, neuropathy, vision loss, and vascular disease. Screening It is recommended that women with PCOS be routinely screened for insulin resistance so that it can be identified early, allowing earlier initiation of treatment. Tests used to screen for insulin resistance include: Fasting Blood Glucose Test: You will be instructed to abstain from food and drinks for a specific amount of time before your blood is drawn to check your blood sugar level. If your level is elevated, your doctor may want you to take further tests to determine how your body processes sugar. Glucose Tolerance Test: Your blood sugar level will be checked, and then you will be given a special drink containing sugar. Your blood sugar will then be measured at designated intervals after you have consumed the drink to see how long it takes for your cells to process the sugar. If your glucose levels remain elevated for longer than normal, this may indicate that you are becoming resistant to insulin. Glycosylated Hemoglobin A1C: This is a blood test that measures your average glucose levels over the past three months. A Word From Verywell While there is no cure for diabetes, it can be managed with dietary modification and medication. A number of steps can be taken to identify insulin resistance before diabetes occurs. If you have PCOS, some healthy lifestyle habits can help prevent diabetes long before tests would be expected to show abnormalities. Incorporating daily exercise into your routine has been associated with a reduced risk of diabetes. Eating a well-balanced diet, low in fats and sugars, and rich in whole grains, low-fat dairy products, fruits, and vegetables have also been shown to reduce the risk of diabetes. Dietary supplements recommended for women with PCOS may help as well; ask your doctor if they are right for you. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clin Epidemiol. 2013;6:1-13. doi:10.2147/CLEP.S37559 Wilcox G. Insulin and insulin resistance. Clin Biochem Rev. 2005;26(2):19-39. Wang ET, Calderon-Margalit R, Cedars MI, et al. Polycystic ovary syndrome and risk for long-term diabetes and dyslipidemia. Obstet Gynecol. 2011;117(1):6-13. doi:10.1097/AOG.0b013e31820209bb Moghetti P. Insulin Resistance and Polycystic Ovary Syndrome. Curr Pharm Des. 2016;22(36):5526-5534. doi:10.2174/1381612822666160720155855 Motta AB. The role of obesity in the development of polycystic ovary syndrome. Curr Pharm Des. 2012;18(17):2482-91. doi:10.2174/13816128112092482 Andersson S, Ekman I, Lindblad U, Friberg F. Perceived symptoms in people living with impaired glucose tolerance. Nurs Res Pract. 2011;2011:937038. doi:10.1155/2011/937038 Rask-madsen C, King GL. Vascular complications of diabetes: mechanisms of injury and protective factors. Cell Metab. 2013;17(1):20-33. doi:10.1016/j.cmet.2012.11.012 Lunger F, Wildt L, Seeber B. Accurate screening for insulin resistance in PCOS women using fasting insulin concentrations. Gynecol Endocrinol. 2013;29(6):541-4. doi:10.3109/09513590.2013.774362 Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147-67. doi:10.2337/dc10-9990 Additional Reading Bicer M,Alan M,Alarslan P,et al. Circulatinginsulin-like peptide 5 levels and its association with metabolic and hormonal parameters in women with polycystic ovary syndrome. J Endocrinol Invest.2018 Jun 28. doi: 10.1007/s40618-018-0917-x. [Epub ahead of print] Moghetti P. Insulin Resistance and Polycystic Ovary Syndrome. Curr Pharm Des. 2016;22(36):5526-5534. Mu L,Zhao YLai Y,Li R,Qiao J. Insulin resistanceand β-cell dysfunction and the relationship with cardio-metabolic disorders among women with polycystic ovary syndrome. Clin Endocrinol (Oxf).2018 Aug 14. doi: 10.1111/cen.13832. [Epub ahead of print]