Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age, affecting 6-15% of the global population.
PCOS significantly increases the risk of women developing type 2 diabetes due to increased insulin resistance.
Conversely, having type 1 diabetes appears to increase the risk of developing PCOS. This may be due to excess insulin therapy, insulin resistance, and/or subsequent hormonal changes.
What is PCOS?
Polycystic Ovary Syndrome (PCOS) is often seen as a reproductive condition — something to do with periods, ovaries, or fertility. But that’s only part of the story.
PCOS is a complex hormonal and metabolic condition. It affects not only the ovaries but the whole body — including how we process glucose, store fat, regulate cholesterol, and respond to stress. And for many, it sits at the crossroads of something even bigger: the rising tide of insulin resistance and type 2 diabetes, especially among young people, and those from communities already carrying an unfair burden of chronic disease.
PCOS is possibly one of the earliest visible signs of metabolic dysfunction in girls and women — often showing up as early as adolescence. It can be a clue that the body is struggling to maintain balance long before a diagnosis of diabetes or heart disease is made.
Insulin Resistance – The link between PCOS and Type 2 Diabetes
For many women with PCOS, insulin resistance is not only present, it’s a key driver of the hormonal imbalance that is occurring. Yet it’s often overlooked. Understanding how insulin works – and why insulin resistance develops – could potentially unlock new ways of managing PCOS and diabetes with more direct and appropriate approaches.
What Is Insulin?
- Insulin is a hormone made by the pancreas. Its main job is to help glucose (sugar) from the food we eat move into the body’s cells, where it’s used for energy.
- When we eat, blood glucose rises.
- The pancreas releases insulin.
- Insulin acts like a key, unlocking the cell doors so glucose can enter.
- Once inside cells, glucose can fuel the muscles, feed the brain, or support other essential body functions. Any excess glucose is stored as glycogen in the short term in case it’s needed later. (Any further surplus glucose is converted to fat)
For more on insulin, see ‘Diabetes and Insulin’
What Is Insulin Resistance?
In insulin resistance, the body’s cells stop responding properly to insulin’s signal. The “key” doesn’t fit the lock as well. So the pancreas has to make more and more insulin to get the same effect.
This leads to:
- High insulin levels in the blood (hyperinsulinaemia)
- Glucose eventually rising too (prediabetes or Type 2 diabetes)
- Hormonal disruptions — especially increased androgens (male hormones)
How Does Insulin Resistance Affect PCOS?
Insulin resistance is thought to be present in up to 80% of people with PCOS, including many with a healthy body size. It plays a central role in PCOS by:
- Stimulating the ovaries to produce more androgens (e.g. testosterone)
- Disrupting ovulation and menstrual cycles
- Increasing fat storage and making weight loss harder
- Increasing the risk of type 2 diabetes, heart disease, and inflammation
This creates a vicious cycle:
Insulin resistance → more insulin → more androgens → more PCOS symptoms → more insulin resistance
For more on Insulin Resistance, see the page, ‘Insulin Resistance’
Q. Can you have PCOS without Insulin Resistance?
Yes! — Not everyone with PCOS has insulin resistance, and not everyone with insulin resistance has PCOS. But when it is present, addressing it directly can be one of the most effective ways to improve symptoms and long-term health.
Lifestyle Matters — But It’s Not Your Fault
People with PCOS are often unfairly told to “just lose weight” or “eat better.” This blames the person for a condition that is largely driven by biology, hormones, and inherited traits.
Insulin resistance can occur regardless of body size, ethnicity, or lifestyle — and it may be influenced by:
- Genetics (family history of diabetes, PCOS, or heart disease)
- Stress and poor sleep
- Hormonal changes
- Early life factors like low birth weight or gestational diabetes exposure
Simple lifestyle changes such as increasing physical activity (moving more), getting a good night’s sleep, and choosing nutritious foods can all promote insulin sensitivity. Remember though, that the goal is improved health, not a perfect figure!
Promoting Insulin Sensitivity
Promoting Insulin Sensitivity is akin to reducing Insulin Resistance
There’s no one-size-fits-all solution, but focus areas to improve insulin sensitivity include:
1. Make Healthy Food Choices
- Emphasise low-glycaemic index carbs
- Balance meals with protein, fibre, and healthy fats
- Avoid overly restrictive dieting — it can backfire!!
2. Increase Physical Activity
- Regular activity (especially strength training and walking) improves insulin response
- Even short walks after meals help lower glucose and insulin
3. Consider your Sleep and Stress levels
- Poor sleep and chronic stress worsen insulin resistance
- Be kind to yourself!
- Prioritise rest, connection, and calm routines
4. Take Medications as Prescribed
- Metformin is commonly used to reduce insulin levels in PCOS
- Some people benefit from inositol supplements (see glossary)
5. Use your Support Network
Support is more effective when it’s personalised and culturally safe and might be from immediate family members, or your extended whānau.
Mental Health and Insulin Resistance
PCOS and insulin resistance are strongly linked with depression, anxiety, and body image distress — not only due to physical symptoms, but because of how people are treated. A strengths-based, non-blaming approach is essential.
Healing is not just clinical or metabolic — the emotional, social, and spiritual elements are equally important. Yet when it comes to women’s health these elements are so often overlooked… Be sure to prioritise your life accordingly!!
PCOS and Type 1 Diabetes
The relationship between type 1 diabetes and polycystic ovary syndrome (PCOS) is not as well-known nor as widely studied as the link between PCOS and type 2 diabetes / insulin resistance.
However, yes it is true that:
People with type 1 diabetes appear to have a higher risk of developing PCOS compared to the general population
Insulin therapy is essential in type 1 diabetes. However, high insulin doses over time (especially if there’s some degree of insulin resistance) can increase androgen (male hormone) production, which plays a significant role in PCOS.
Insulin resistance can still develop in people with type 1 diabetes — this is sometimes called “double diabetes” (type 1 diabetes with additional features of type 2, particularly insulin resistance). Insulin resistance is noted as a key feature of PCOS.
Menstrual irregularities, hyperandrogenism (acne, excess hair), and polycystic ovaries on ultrasound may be more common in females with type 1 diabetes than in those without diabetes.
Research suggests that up to 30% of females with type 1 diabetes may meet criteria for PCOS — much higher than the general population rate (usually estimated at 8–13% depending on diagnostic criteria and ethnicity).
Some studies suggest that the longer the duration of diabetes and the higher the insulin requirement, the more likely PCOS may occur.
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Summary:
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