The Link Between PCOD and Insulin Resistance

The Link Between PCOD and Insulin Resistance

Polycystic Ovarian Disease (PCOD), also known as Polycystic Ovary Syndrome (PCOS), is a common endocrine disorder affecting millions of women worldwide. While many associate PCOD primarily with reproductive issues like irregular periods and infertility, its roots run much deeper—particularly into the body’s metabolic processes. One of the most significant and well-established connections is between PCOD and insulin resistance.

Understanding Insulin Resistance

Insulin is a hormone produced by the pancreas that enables cells to absorb glucose from the bloodstream for energy. In insulin resistance, the body’s cells become less responsive to insulin, forcing the pancreas to produce more of it. Over time, this can lead to elevated insulin levels (hyperinsulinemia), higher blood sugar, and eventually type 2 diabetes.

How Insulin Resistance Drives PCOD

Insulin resistance is not just a side effect of PCOD—it’s a central driver of the condition. Studies show that:

  • 70–95% of women with obese PCOD and 30–75% of those with lean PCOD have insulin resistance.
  • High insulin levels stimulate the ovaries to produce more androgens (male hormones), such as testosterone, which can disrupt ovulation, cause irregular periods, acne, and excess hair growth.
  • Insulin resistance is also linked to increased inflammation, weight gain, and a higher risk of developing type 2 diabetes and cardiovascular disease.

The Vicious Cycle: Obesity, Insulin, and PCOD

Obesity amplifies insulin resistance. In women with PCOD, excess adipose (fat) tissue releases substances called adipokines, which further disrupt insulin signaling and hormone balance. This can worsen both metabolic and reproductive symptoms of PCOD, creating a vicious cycle.

Testing and Diagnosis

Because insulin resistance is so common in PCOD, testing for it is often recommended. Common tests include:

  • Fasting insulin
  • HOMA-IR index
  • 2-hour insulin glucose challenge test

These tests help distinguish PCOD from other conditions with similar symptoms and guide treatment.

Managing PCOD and Insulin Resistance

Addressing insulin resistance is a cornerstone of PCOD management:

  • Lifestyle changes: Diet, exercise, and weight loss can significantly improve insulin sensitivity, reduce androgen levels, restore ovulation, and improve fertility.
  • Medications: Metformin is commonly prescribed to improve insulin sensitivity and lower blood sugar. It can also help with weight loss and reduce androgen levels.
  • Other agents: Thiazolidinediones (like pioglitazone) are sometimes used but have limitations due to side effects.

Long-Term Health Risks

Women with PCOD and insulin resistance face an increased risk of:

  • Type 2 diabetes: More than half of women with PCOD develop it by age 402.
  • Heart disease and metabolic syndrome: Due to chronic inflammation, abnormal cholesterol, and high blood pressure.
  • Gestational diabetes: Higher risk during pregnancy.

Conclusion

The link between PCOD and insulin resistance is strong and multifaceted. Recognizing and addressing insulin resistance is crucial for managing PCOD symptoms, improving fertility, and reducing long-term health risks. Early intervention with lifestyle changes and, if necessary, medication can make a significant difference in outcomes for women with PCOD.

Dr. Praveen Kumar N S

MBBS, MD (Gen. Med.), DNB (Endocrinology)
Consultant Endocrinologist & Diabetologist
Dr. Praveen's Endocrine Centre
Mysuru, Karnataka. 570009.


References

  1. Insulin Resistance in Polycystic Ovarian Syndrome - PMC3
  2. All Women With PCOS Should Be Treated For Insulin Resistance - PMC4
  3. The link between PCOS and insulin resistance - HelloClue1
  4. Drug Treatments for Polycystic Ovary Syndrome - AAFP5
  5. Diabetes and Polycystic Ovary Syndrome (PCOS) - CDC
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