ConditionsDraft: awaiting clinical review

Insulin resistance

When the body needs more insulin than usual to keep blood sugar in range, a common feature of PCOS.

Overview

Insulin helps move glucose from the blood into the body's cells. In insulin resistance, cells respond less well, so the pancreas makes more insulin to compensate.

Higher insulin levels can increase androgen production by the ovaries and lower SHBG, which is one reason insulin resistance and PCOS are closely linked.

What is well established

Insulin resistance is common in PCOS, including in people of a healthy weight, and is more pronounced with a higher BMI.
HbA1c or an oral glucose tolerance test are used to check for prediabetes and diabetes.
Physical activity and changes to diet improve insulin sensitivity.

Uncertain or emerging evidence

There is no single standardised test for insulin resistance in routine clinical practice. Fasting insulin and calculated scores (such as HOMA-IR) vary between laboratories and are mainly research tools.
The benefit of insulin-sensitising medicines specifically for improving fertility is more limited than that of first-line ovulation treatments.

This guide is general information and does not replace advice about your own circumstances. Clinical review pending.