In this science-backed episode of PCOS Unfiltered, we’re pulling back the curtain on one of the most misunderstood, under-diagnosed, and under-discussed root causes of PCOS: insulin resistance. (yes, again) Inspired by a 2023 review in the Journal of Ovarian Research, I break down how insulin resistance doesn’t just impact your blood sugar — it affects your liver, fat tissue, and ovaries, amplifying hormone imbalances and metabolic dysfunction. Whether you are told everything is “normal” or you’re navigating symptoms like irregular cycles, acne, or hair growth, this episode will help you understand what’s happening under the surface — and how to catch it early before it leads to long-term complications. You’ll learn why fasting insulin matters more than A1c, what the latest research says about treatment options (including lifestyle changes and medications like metformin and GLP-1s), and how to reclaim your health with real strategies that go beyond the fads.
In this episode, I cover:
Two key treatment pathways:
The difference between managing and healing PCOS with the right approach
https://ovarianresearch.biomedcentral.com/articles/10.1186/s13048-022-01091-0?.com
I'll be joined by 5 other speakers who have healed beyond their own diagnosis and are giving you all the tools to do the same.
If today’s episode gave you clarity or encouragement, hit subscribe and leave a quick ⭐⭐⭐⭐⭐ review—it helps more women like you find their way to real healing.
(0:03 - 0:17) Welcome to PCOS Unfiltered, nourish, heal, thrive. The place where real talk meets real healing. I'm your host, Lindsie, a health and nutrition coach, mindful eating advocate, and fellow health warrior.
(0:18 - 0:36) Each week we're diving deep into the truth about PCOS, from nutrition and mindful habits to emotional healing and everything in between. All without the filters, the fads, or the shame. If you're ready to ditch the diets, listen to your body, and finally thrive, you're in the right place.
(0:37 - 0:57) Now, as a reminder, the content shared on PCOS Unfiltered is for informational and educational purposes only. The views and opinions expressed by the hosts and guests are not intended to serve as medical advice. Always consult with a qualified healthcare professional before making any changes to your diet, exercise, or treatment plan.
(0:58 - 1:40) The information shared is based on personal experience and expert interviews and is not a substitute for professional medical guidance. This episode is inspired by a 2023 review published in the journal of ovarian research, and it is titled insulin resistance and polycystic ovary syndrome across various tissues in updated review of pathogenesis, evaluation, and treatment. What does that even mean? So we're going to unpack what the research reveals, why insulin resistance is such a game changer in PCOS, and how understanding it can guide better treatment and real healing.
(1:40 - 1:55) Yes, I talk about insulin resistance a lot. I feel like in some form it gets brought up in just about every single one of my episodes. And that is because it is super important.
(1:55 - 2:18) I think the more research that comes out shows the role that it's playing in many conditions, but also specifically with PCOS. PCOS is one of the most common endocrine disorders in women. And as you may or may not know, it is marked by irregular ovulation and elevated androgens and possibly cysts on the ovaries.
(2:18 - 2:52) And I say that because you don't even need to have ovarian cysts anymore to be diagnosed because insulin resistance is playing a role here. And so what powers these symptoms often goes unseen, and that's where the insulin resistance comes in. So this review emphasizes that recognizing insulin resistance early, assessing it accurately and managing it effectively are vital to reducing long-term complications associated with PCOS.
(2:53 - 3:10) Think of insulin resistance as a hidden fuel. It worsens hormone imbalance, affects reproductive health, metabolic health, and just so much more. And so understanding it can change how we approach treatment, and that is from the study.
(3:11 - 3:23) First, let's clarify the basics. PCOS is characterized by chronic problems in ovulation and androgen excess. Remember, androgen are those male hormones.
(3:24 - 3:48) And what this means is that symptoms like irregular menstrual cycles, acne, hair growth, especially on the face, you know, may be something that you're dealing with. Insulin resistance occurs when bodily tissues like muscle, fat, and liver become less responsive to insulin. So your body compensates by pumping out more insulin leading to elevated insulin levels.
(3:48 - 4:09) And this is known as hyperinsulinemia. This overload of insulin can ripple through various tissues. Now, if you caught my three-part series, when I kicked off this podcast, I always recommend going back and revisiting those again because it comes up so much and that kind of gives you just some basic, basic groundwork.
(4:10 - 4:27) But in that I do talk about the role insulin plays in several systems throughout your body. So anyways, this overload can ripple through various tissues. And what that does is it can worsen PCOS symptoms, and it really creates a vicious metabolic cycle.
(4:27 - 4:45) So the reviewed study explains that this relationship is central across multiple body systems. Next, let's explore how insulin resistance fuels PCOS. The review synthesizes recent findings on mechanisms.
(4:45 - 5:25) So specifically talking about in the liver for the first one, and in the liver, insulin resistance impairs the metabolism of glucose or sugar, and it increases lipid or fat production, and this creates metabolic stress. In adipose tissue, which is a connective tissue, basically where you store fat, the high insulin levels promote fat accumulation and disrupt normal hormone metabolism. And then you have in the ovaries, elevated insulin amplifies androgen production, again, those male hormones, and this disrupts ovulation and then contributes to PCOS features.
(5:26 - 5:54) So this kind of interplay across tissues, specifically the liver, fat, and ovaries, creates a compounded effect, which means it's metabolic dysfunction that contributes to reproductive dysfunction, and then that in turn worsens the metabolic imbalance. So again, just kind of becomes a vicious cycle. So let's kind of dive a little bit deeper here, starting with the liver.
(5:55 - 6:40) Impaired insulin signaling here leads to increased gluconeogenesis, and so that's where your body is using non-carbs, basically, to kind of keep your blood sugar levels steady. So think about this, if you fast, and whether that means either overnight or if you're intentionally fasting, that's what's going to get you through those times, or maybe more intense exercise, something like that, that's going to help keep your blood sugar levels steady. And then there's the lipogenesis as well, that's using carbs to basically turn those into fatty acids.
(6:40 - 7:22) And so the study highlights how these shifts worsen both blood sugar and lipid profiles. As far as the adipose or fat tissue, insulin resistance alters how fat cells handle the glucose and the hormones, and this can raise circulating androgens and inflammatory markers, again, further feeding PCOS symptoms. And then with the ovarian tissue, you have elevated insulin, which enhances or amplifies those male hormones, the synthesis of those male hormones, and this disrupts follicle development and ovulation, which, as you may or may not know, lies at the heart of PCOS reproductive issues.
(7:23 - 8:09) So by breaking it down tissue by tissue, the review gives us insight into how a systemic problem manifests differently in each part of the body, and especially for the parts of the body specific for PCOS. How do we measure insulin resistance in a clinical context? Again, I've talked about this before. Insulin level is what I always ask for if I can, and while the review summarizes various evaluation tools, it emphasizes the importance of early and accurate assessment, and this means that fasting insulin level, yes, you can get a fasting glucose or a fasting A1c, but those compensate, as I've talked about before.
(8:09 - 8:38) So those can be normal for a very long time, while the insulin level could potentially be elevated and show signs of insulin resistance far in advance of the glucose or the A1c being out of whack. The main takeaway here is early detection enables effective interventions that reduce long-term risks. So what can be done? So if you even suspect that you have something like this, you don't necessarily have to rush out to your doctor.
(8:40 - 9:03) This review actually outlines two main strategies. One thing that you can do starting today is lifestyle intervention, and that could be changing your diet. I mean, I've talked about different ways to approach that, whether that means focusing on breakfast or adding versus subtracting and really focusing on bringing in some good nutrients for your body.
(9:04 - 9:19) You know, exercise. I always focus on diet over exercise or nutrition, really, over exercise. But yes, exercise is still great, and I don't really like the term exercise too much either.
(9:19 - 9:51) It's really more about movement. So just moving your body, going for a walk, 10 minutes, 20 minutes, whatever, a little bit more than what you would have done before, a few times a week to start, whatever it might be, but just moving your body. And those can help with weight management, of course, and that remains the first line therapies for all women with PCOS, which can improve insulin sensitivity, affecting ovulation, bettering ovulation, and producing better metabolic outcomes.
(9:52 - 10:22) The other option, yes, if you want to visit your doctor, metformin kind of remains the gold standard for that, and that reduces that gluconeogenesis, though, and intestinal glucose absorption and lipogenesis. That's a mouthful there. So it's kind of doing the work for you, where if you are making the lifestyle interventions or changing some things on your own, your body's going to kind of naturally adjust.
(10:23 - 11:03) There are some other emerging options, of course, like GLP-1s, for example, but you have to consider side effects, contraindications, and just personalize considerations here because everybody is so different, and no matter what you choose, just educate yourself, really, about what you're doing. And maybe the metformin might be kind of a little bridge as you're making some changes in your lifestyle. The key message from this study, though, is that combining lifestyle changes with appropriate pharmaceuticals can significantly reduce PCOS symptoms and long-term complications.
(11:04 - 11:29) And you have to think, too, if that medication is something that you really want to be on long-term. Like I said, can it kind of bridge the gap as you're making some lifestyle changes? Because then eventually you can just focus on the lifestyle changes and live your life that way. So as we wrap up, insulin resistance is not just a side player, but it is a central multi-tissue driver of PCOS.
(11:29 - 11:48) I mean, like I said, I feel like I can't stress that enough. It doesn't get recognized, I think, like it should. And you have to understand its impact on the liver, the fatty tissues, and the ovaries.
(11:48 - 12:08) And that helps us grasp the full picture. And then again, the big takeaway from all of this is that early detection and targeted treatment, so again, both lifestyle and maybe possibly medication can offer real hope for better outcomes. Of course, I will link the study for this in the show notes.
(12:08 - 12:24) So if you're intrigued, feel free to check out the full review for deeper detail there. Thanks for tuning in to another episode of PCOS Unfiltered. If today's episode spoke to you, be sure to subscribe so you don't miss a thing.
(12:25 - 12:34) And if you loved it, a quick review would mean the world to me. Remember, healing is a journey, not a destination. And you deserve to feel empowered every step of the way.
(12:35 - 12:39) Until next time, nourish your body, heal your heart, and thrive like the boss you are.