Insulin resistance is at the heart of many PCOS symptoms. High levels of insulin can stimulate the Insulin resistance and is one of the key drivers behind many PCOS symptoms, but it’s often misunderstood.
If you have PCOS, your body may produce insulin normally, but your cells do not respond to it as they should, i.e., they become ‘resistant’. In response, your body makes even more insulin to compensate. Over time, high insulin levels can affect many systems in the body, especially the ovaries and hormone balance.
- The link between insulin and hormones
- What is insulin resistance?
- Signs that insulin resistance may be a factor
- How metformin helps with insulin resistance
- When metformin might be recommended
- What to expect with side effects
- Is it right for everyone?
- Finding what works for you
The link between insulin and hormones
Insulin is best known for helping regulate blood sugar, but it also affects how your body produces and balances other hormones. In people with PCOS, excess insulin can stimulate the ovaries to produce more androgens, like testosterone. Higher levels of androgens can disrupt ovulation, affect egg development and lead to common PCOS symptoms such as irregular periods, acne and excess hair growth.
Insulin also influences how your body stores fat, how often you feel hungry and how your reproductive hormones work together. Over time, this imbalance can create a cycle where insulin resistance worsens PCOS symptoms, and those symptoms, such as weight gain and hormone disruption, make insulin resistance harder to control.
What is insulin resistance?
Insulin resistance means the body’s cells are not responding well to insulin, making it harder for glucose to move from your blood into your muscles, liver and fat. As a result, your pancreas produces more insulin to try and keep blood sugar levels steady.
This condition is common in people with PCOS, even in those who are not overweight. In fact, around 70 percent of people with PCOS show signs of insulin resistance. Because insulin has such a wide-reaching effect on the body, this resistance can play a major role in fertility difficulties and your general health.
Signs that insulin resistance may be a factor
Not everyone with PCOS has insulin resistance, but some symptoms might suggest it is involved. These can include:
- Fatigue after eating or energy crashes
- Weight gain, particularly around the stomach
- Sugar or carb cravings
- Skin tags or dark patches of skin on the neck or underarms
- Irregular or missing periods
- A family history of type 2 diabetes
At Care Fertility, we look for these signs during your initial assessment and use a single targeted blood test which allows us to know what your sugar control has been over the prior few months.
How metformin helps with insulin resistance
Metformin is a well-established treatment for type 2 diabetes, but it’s also used to support fertility in some people with PCOS, especially when insulin resistance is present. Instead of increasing insulin levels, metformin helps your body respond more effectively to the insulin it already produces. This reduces insulin levels and improves the overall hormone balance.
Metformin can help by:
- Lowering insulin and blood sugar
- Reducing testosterone levels
- Potentially support more regular periods and ovulation
- Helping with weight management in some people
- Lowering the risk of developing type 2 diabetes in the long term
While metformin does not directly trigger ovulation, it helps create a hormonal environment where ovulation becomes more likely.
When metformin might be recommended
Metformin is often suggested when insulin resistance is a contributing factor to fertility challenges. It may be included in your treatment plan if:
- You have PCOS and have insulin resistance
- Your blood tests show high glucose levels
- There is some evidence that Metformin may reduce miscarriage risk
Metformin is usually part of a broader plan that may include changes to your diet, gentle movement and stress management. These changes can improve your body’s sensitivity to insulin and support the effects of medication.
The role of Metformin in PCOS is less certain than in type 2 diabetes but nonetheless in some clinical situations your doctor may still feel it may be beneficial for you.
What to expect with side effects
Like any medication, metformin can cause side effects, especially when you first start taking it. The most common are:
- Nausea or an unsettled stomach
- Loose stools or diarrhoea
- Bloating or wind
- A metallic taste in the mouth
These symptoms usually ease over time. Taking metformin with food and starting with a low dose that is gradually increased can help make it easier to tolerate. If the side effects continue, your doctor may suggest adjusting the dose or switching to an extended-release version.
Is it right for everyone?
Metformin is not suitable for everyone with PCOS. If your insulin and sugar levels are normal and you are ovulating regularly, there may be no benefit to taking it. That is why accurate testing is so important.
It is also important to remember that metformin is not a cure for PCOS. It can improve some symptoms and support ovulation, but it works best when it is part of a tailored plan that fits your individual needs.
Finding what works for your body
PCOS can be complex, especially when insulin resistance plays a role in symptoms and fertility. Metformin is one useful option that may help bring hormones back into balance. It works best when combined with lifestyle changes and other fertility treatments, depending on your personal situation.
If you are thinking about starting a family and PCOS is making it difficult, you are not alone. We are here to help you understand your body and explore the treatment options that could make a real difference for you.
