If you don’t have polycystic ovarian syndrome (PCOS), you may be surprised to hear that this is one of the most common hormonal conditions in the world: About 10-20% of people with ovaries have PCOS. And if you do have PCOS, you might be overwhelmed with trying to find a doctor who will listen, get medication refills, sift through targeted ads on social media, and juggle book recommendations you didn’t ask for.
For a condition that is unfortunately so common, it can be hard to get straight answers and the right kind of support. Many people with ovaries put the pieces together themselves, long before a doctor confirms with an official diagnosis.
PCOS has noticeable impacts. People with ovaries can often tell they have the syndrome, and evidence shows they are right most of the time. Here are some key signs:
- PCOS can change the menstrual cycle, making it longer and more irregular.
- Skin and hair issues are common, like painful cystic acne or pimples on the jawline, unwanted hair growth on the face, chest, abdomen, or hair loss and thinning from the scalp.
- A person may feel symptoms of metabolic issues, like intense cravings for sweets or stubborn and persistent weight gain.
- Blood tests may show abnormal cholesterol and blood sugar levels.
While the root causes of PCOS may include family genes, lifestyle (since infancy), chronic stress, or even the gut microbiome, researchers agree that hormones and metabolism both play key roles.
Connecting PCOS and Insulin Resistance
PCOS can be described as both a reproductive and metabolic condition. This means it affects not only the ovaries, but also how the body uses energy from food. One key feature of this syndrome and its impact on metabolism is something called insulin resistance.
Understanding the link between PCOS and insulin resistance can help guide your personal treatment plan.
What is insulin? Insulin is a hormone made by the pancreas. Its job is to help move sugar (glucose) from the blood into the cells, where it can be used for energy. Insulin is like a key that opens the doors of the cells.
What is insulin resistance? With insulin resistance, the body’s cells do not respond well to insulin — the key isn’t fitting the lock anymore, or maybe there aren’t enough keys to open all the doors. And as a result, the body will make more and more insulin, trying to keep blood sugar stable. But it’s not working.
In PCOS, insulin resistance is very common: estimates suggest 50-95% of people with PCOS have insulin resistance. This is even if the person is not in a larger body, and even if blood glucose tests appear to be normal.
Ok wait, so what is really happening in my body? High insulin levels can affect the ovaries. When insulin is elevated, it can signal the ovaries to make more androgens (sometimes called “male hormones”). This increase in androgens (more testosterone but also less of a hormone called sex-binding globulin that should keep hormones in balance) can lead acne, excess facial or body hair, and irregular periods. Over time, the imbalance may fully disrupt ovulation.
How can I tell if I have insulin resistance? The most official way to know if you have this is by asking a doctor about lab tests for blood sugar and insulin levels. Some people might actually feel certain aspects of insulin resistance. It could feel like a big wave of anxiety or tension that comes with feeling very hungry, overwhelming sugar cravings, or big drops in energy during the day, even after eating.
What if I already have been diagnosed with diabetes? If you have gotten a diagnosis of prediabetes or type 2 diabetes, it might be time to connect the dots with your menstrual cycle, fertility, mood, and energy levels. Working with an expert like a PCOS-specialized dietitian endocrinologist could help improve your life with PCOS.
Empowered Approaches to PCOS
Improve your personal PCOS experience by:
- Tracking: Symptom & cycle tracking can give you key insights into your health. Try writing using a note on your phone or a tracking app like Clue, Flo, Bearable, or Go Go Gaia. Or go analog and get a small calendar book you can carry. Tracking can be especially helpful before and after starting any treatments, to be sure of what is or isn’t working for you.
- Write it Down: Journaling can give you a lot of information, whether it’s free writing for 5-10 minutes each day, or jotting down food choices along with your hunger levels and mood at the time.
- Talk it Out: Talk therapy may help someone with PCOS deal with the anxiety or depression, unpack negative experiences they’ve had at the doctor’s office, find the words to talk about your unique needs or advocate for care, and learn behavioral skills to help deal with any disordered eating habits.
- Be Prepared: Bring a written list of questions and requests to your medical appointments, so you don’t miss anything!
- Build your Team: Many people with PCOS will have a core support team that includes a gynecologist, endocrinologist (a hormone-specialized doctor), registered dietitian nutritionist, and therapist.
Lifestyle for PCOS & Insulin Resistance
Thankfully, there is much we can do with lifestyle to help balance insulin, sex hormones, and metabolism. Lifestyle can shape our PCOS, for better or worse.
It’s been shown that PCOS-related insulin sensitivity can be improved with:
- Balanced meals focusing on protein and fiber from whole grains, beans, nuts, seeds, & colorful fruits and vegetables
- Regular movement and exercise, including walking, stretching, strength training, and cardio
- Consistent stress care habits, like therapy, connecting with loved ones, or breathing exercises
- Evidence-based supplements, like vitamins, minerals, and herbs, can also help people with PCOS
Keep in mind, PCOS is not a one-size-fits-all situation.
Final Thoughts
PCOS is not just about the ovaries, and it’s not just managed with medications. It’s a whole-body condition that needs a whole body (and mind) approach. And that approach needs to make sense for you — your culture, habits, preferences, budget, and schedule.
Make an appointment with a PCOS-dietitian to talk about your PCOS experience and figure out the next steps in your personalized PCOS plan.
References
- Prosperi S, Chiarelli F. Insulin resistance, metabolic syndrome and polycystic ovaries: an intriguing conundrum. Front Endocrinol (Lausanne). 2025 Oct 1;16:1669716. doi: 10.3389/fendo.2025.1669716. PMID: 41103651; PMCID: PMC12520869.
- Chen X, Wan Y, Xie L. Insulin resistance in polycystic ovary syndrome: pathophysiological mechanisms of menstrual dysfunction and evidence-based treatment strategies. Biol Reprod. 2025 Dec 16;113(6):1340-1354. doi: 10.1093/biolre/ioaf197. PMID: 40883896.
- Senthilkumar H, Arumugam M. Gut microbiota: a hidden player in polycystic ovary syndrome. J Transl Med. 2025 Apr 15;23(1):443. doi: 10.1186/s12967-025-06315-7. PMID: 40234859; PMCID: PMC11998441.
- Damoulaki E, Sioutis D, Sarli V, Trakakis E, Mastorakos G, Katoulis A, Kastrinakis K, Koratzanis C, Machairiotis N, Panagopoulos P, Christodoulaki C. Polycystic Ovary Syndrome-Associated Acne: The Interplay of Hyperandrogenism, Insulin Resistance, and Therapeutic Strategies. Cureus. 2025 Nov 29;17(11):e98103. doi: 10.7759/cureus.98103. PMID: 41473651; PMCID: PMC12747725.
OKAY TO EAT 