Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder. It is estimated that anywhere from 5-10% of women of reproductive age have PCOS. It is characterised by irregular periods, high levels of androgens (acne, excessive body hair) and enlarged ovaries with multiple cysts on ultrasound. Although PCOS is a reproductive order, one of the key features is insulin resistance. This means the body doesn’t respond well to insulin and has difficulty removing sugar from your bloodstream. Insulin resistance has been linked to many inflammatory diseases, including a higher risk for diabetes. When it comes to your fertility, insulin resistance can also increase your risk of miscarriage and pregnancy complications. 

Why does this matter

Regardless of body weight, the majority of individuals with PCOS will have some degree of insulin resistance. We can measure insulin resistance using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). This looks at the relationship between fasting blood glucose levels and fasting insulin. 

Let’s go back in time to when I was a student studying naturopathic medicine. During one of our classes, we had to practise finger prick tests to assess fasting blood glucose levels on each other. My levels came back sky high. When I did blood work for both my fasting glucose and insulin, my HOMA-IR wsa 2.0, indicating early insulin resistance. This was one of the first steps in getting diagnosed with PCOS. 

The reason we care about insulin is because it drives many of the unwanted symptoms of PCOS. To start with, too much insulin in the blood makes you feel crappy and tired, like you just ate a giant thanksgiving dinner.  No one likes that. No one. High insulin can cause high levels of testosterone by increasing production in the ovaries. This can block ovulation and cause numerous unwanted symptoms such as hirsutism (excessive body hair), hair loss on the scalp and stubborn cystic acne. 

When it comes to fertility, excessive insulin can impair blood flow to the uterus and increase the risk of miscarraige. It also damages the mitochondria in our ovaries, which can decrease egg quality.. To treat your PCOS effectively, we need to treat your insulin. We can use insulin sensitising herbs, nutraceuticals and lifestyle changes to manage your symptoms and promote better hormone health. Although I see many patients who’ve had their glucose levels tested, it is rare that they’ve actually looked at their insulin levels. That’s why we need to test both to accurately determine one’s level of insulin resistance and overall risk. 

Signs and Symptoms of Insulin Resistance

  1. Do you feel shaky and nervous if you do not eat? Or do you feel hungry even though you just ate?
  2. Do you find that you are sensitive to high sugar foods?
  3. Do you have a history of an eating disorder, especially
    binge eating disorder?
  4. Do you have brown or black hyper-pigmented skin
    around the folds of your armpits or neck?
  5. Have you been diagnosed with type 2 diabetes, or told
    that you are prediabetic?
  6. Do you feel sluggish and tired after consuming a large meal, particularly one that is heavy on carbohydrates? 

Since giving birth almost a year ago, I’ve been working hard at managing my PCOS naturally. My latest blood work was my best yet, my HOMA-IR was down to 0.9. This didn’t happen naturally, nor did it take extreme dietaring, thousands of supplements or an overly complicated plan. It means prioritising exercise, optimising my nutrient status and targeted supplements to improve my insulin sensitivity. Regardless of body weight, we should be testing and treating all patients with PCOS for insulin resistance.

Have you had your insulin levels looked at? Are you curious to learn more about this topic? I invite you to work with me on your hormone health by booking an appointment with me here. You can also grab a copy of my new book My PCOS Pregnancy: Your Guide to getting and Staying Pregnant with PCOS.

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As a Naturopathic Doctor and IVF mama herself, Dr. Laura von Hagen fundamentally believes in empowering her patients to achieve their ultimate goal, healthy pregnancy and baby. While it is common to feel isolated and uncertain while trying to conceive. Dr. Laura provides the support that patients deserve when navigating their fertility journey.