Insulin Resistance / Metabolic Dysfunction

Insulin resistance is a condition in which the cells of the body respond poorly to insulin. The body must make more and more insulin to move sugar (glucose) into cells. In reproductive health, insulin resistance matters most in polyendocrine metabolic ovarian syndrome (PMOS), formerly polycystic ovary syndrome (PCOS).

Insulin resistance is present in an estimated 50 to 70% of people with the condition overall. It is more common and more severe with obesity. It also occurs in lean women with PMOS / PCOS.¹

The link to ovulation problems is direct. High insulin drives theca cells in the ovary to make excess androgens, the male-type hormones. These androgens disrupt follicle growth and suppress ovulation.

This pathway explains much of the infertility caused by absent ovulation across the PMOS / PCOS phenotypes (subtypes). That includes lean PMOS / PCOS, in which insulin resistance can be present without a high BMI.²

Excess androgens can delay or prevent ovulation, which lengthens the cycle. They impair mucus quality as well. They can also disrupt the luteal phase. These effects build on each other and weaken the whole cycle. Viewing insulin resistance as the upstream metabolic driver reframes PMOS / PCOS. The condition becomes a metabolic disorder with hormonal effects, rather than a hormonal disorder.³

Improving the response of the body to insulin can restore ovulation in some women. It can work even without much weight change.⁴ Myo-inositol has a documented role in supporting insulin signaling in PMOS / PCOS. It is one of the nutritional options with published clinical evidence behind it.⁴

Insulin resistance worsens hormonal abnormalities in more than one hormone system. Attention to metabolic health is therefore part of the root-cause workup, rather than an add-on to it.