It is estimated that between 5-10% of women in North America have polycystic ovarian syndrome (PCOS). The name PCOS gives the impression that this syndrome results from an issue in the ovaries. However, PCOS is truly a metabolic condition associated with insulin resistance, hormonal imbalance and inflammation. In fact, you don’t actually need to have polycystic ovaries to be diagnosed with PCOS!
Current research suggests that insulin resistance is a major contributor to PCOS symptoms (weight gain, hair loss, acne, hirsutism, long or missing periods) in up to 70% of all cases of PCOS1! Why these women are prone to insulin resistance is unknown but it is likely related to a genetic predisposition leading to abnormalities in the cellular action of insulin and its receptor2.
What is insulin resistance?
Insulin is a hormone that is released after we eat. Its job is to take sugar from our blood and move it into our cells where it can be used as fuel. In cases of insulin resistance, the body has an exaggerated response when we eat things like sugar and carbohydrates and overproduces insulin. Over time, this overproduction of insulin leads to a reduced sensitivity by the cells.
Since insulin is a storage hormone, chronically high levels seen in insulin resistance lead to increased weight gain around the abdomen. In women with PCOS, elevated insulin also causes the theca cells within the ovary to overproduce male hormones, known as androgens. The increased production of androgens can cause symptoms of acne, hair loss, and dark hair growth on and under the chin.
How do you know if you have insulin resistance?
Most women I see have had their blood sugar tested; however, this is not the same as insulin testing. Blood sugar levels are frequently normal in women with PCOS even if they have quite severe insulin resistance.
Insulin can be tested in the blood in a few different forms. Testing both fasting insulin and glucose is a good starting point, but the best measure of insulin resistance is an insulin glucose challenge test that looks at fasting insulin as well as the response to sugar intake at 30 minutes, 1 hour and 2 hours after ingestion.
How do you treat insulin resistance?
The most important treatment in insulin resistance is to modify your diet! Reducing simple sugars and simple carbohydrates are essential to reduce the exaggerated spikes of insulin worsening symptoms of PCOS.
Exercise allows the body to move sugar into the cells without the need for insulin making it helpful when combating insulin resistance. Some women with PCOS find HIIT helpful, while others find slower, muscle-building exercise is more beneficial.
Several supplements can be added to dietary and movement changes to give your body some extra support. Myo-inositol is a naturally occurring compound and one of my first-line treatments for women with insulin-resistant PCOS. It has been consistently found in research to increase insulin sensitivity, reduce androgen levels and improve ovulation rates3. Myo-inositol has also been found to improve egg quality, fertilization rates and embryo quality in women with PCOS who are going through IVF4.
Dr. Kelly Clinning, ND
Dr. Kelly Clinning is a licensed and registered Naturopathic Doctor (ND) with a passion for research and evidence-based care. Her clinical focus is in treating women’s health with a particular concentration on reproductive health, PCOS, endometriosis and thyroid health. Her goal is to help women connect with their bodies, understand their remarkable physiology, and maintain sustainable balance in their health and life.
Dr. Kelly has her naturopathic prescribing license and incorporates natural desiccated thyroid (NDT) and bio-identical hormone treatment into her practice. She also uses nutrition, botanical medicine, acupuncture, and clinical supplementation.
After graduating from Western University with a Bachelor of Science and an Honours specialization in Kinesiology, she completed a Doctor of Naturopathy (ND) degree from the Canadian College of Naturopathic Medicine in Toronto. She is a member of the Ontario Association of Naturopathic Doctors, the Canadian Association of Naturopathic Doctors, and the Endocrinology Association of Naturopathic Physicians and is in good standing with the College of Naturopaths of Ontario.
- Moghetti, P., 2016. Insulin Resistance and Polycystic Ovary Syndrome. Current Pharmaceutical Design, [online] 22(36), pp.5526-5534. Available at: <https://www.ncbi.nlm.nih.gov/pubmed/27510482>.
- Marshall, J. and Dunaif, A., 2012. Should all women with PCOS be treated for insulin resistance?. Fertility and Sterility, [online] 97(1), pp.18-22. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277302/> [Accessed 28 April 2020].
- Unfer, V., Facchinetti, F., Orrù, B., Giordani, B. and Nestler, J., 2017. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocrine Connections, [online] 6(8), pp.647-658. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655679/>.
- Lesoine, B. and Regidor, P., 2016. Prospective Randomized Study on the Influence of Myoinositol in PCOS Women Undergoing IVF in the Improvement of Oocyte Quality, Fertilization Rate, and Embryo Quality. International Journal of Endocrinology, [online] 2016, pp.1-5. Available at: <https://www.ncbi.nlm.nih.gov/pubmed/27635136>.