Insulin Resistance and PMOS: What's the Link and What Can You Do About It?

If you’re dealing with unpredictable periods, changes in your weight and skin, or tiredness that keeps interrupting your day, being told to “just eat better” isn’t much help. Instead, you need an explanation and a plan that takes your experience seriously. 

Insulin resistance is common in polyendocrine metabolic ovarian syndrome, or PMOS, previously known as polycystic ovary syndrome (PCOS). It affects more than just your ovaries, and it can help explain many of the unexplained hormonal and metabolic symptoms.

Understanding the link between insulin resistance and PMOS can make treatment options clearer and can help you recognise which symptoms need checking. It doesn’t mean that every craving or difficult afternoon is a blood sugar problem. Here, we explain how insulin resistance and PMOS connect, how it’s assessed in the UK and what can help.

What Is Insulin Resistance?

Insulin resistance occurs when some of your body’s tissues respond less effectively to insulin, a hormone your pancreas makes to control blood sugar levels.* Normally, after a meal, insulin levels rise briefly, prompting your liver and muscles to take up sugar from your blood and use it for energy. As a result, your blood sugar levels drop, followed by your insulin levels.

However, with insulin resistance, your blood glucose levels may remain normal, but your insulin levels may be high. If your tissues respond less to insulin, your pancreas compensates by working harder and producing more. Over time, this can cause your blood sugar levels to rise, eventually leading to prediabetes or type 2 diabetes, heart disease and weight gain. Insulin resistance also drives the development of PMOS and is present in up to 70% of people with the condition.**

*Diabetes UK. (No date). Insulin Resistance.

**Chan JL, et al. (2026). Polyendocrine metabolic ovarian syndrome (PMOS)/polycystic ovary syndrome (PCOS): current and future trends.

How Are PMOS and Insulin Resistance Connected?

Insulin resistance is very common in people with PMOS regardless of their body weight, with up to 70% of PMOS patients affected by insulin resistance, but it isn’t present in everyone.* Insulin resistance can contribute to the hormonal changes linked with PMOS, while PMOS-associated hormonal and metabolic factors can worsen insulin resistance. The relationship between the two is complex, and neither condition can be reduced to just one cause.

*Chan JL, et al. (2026). Polyendocrine metabolic ovarian syndrome (PMOS)/polycystic ovary syndrome (PCOS): current and future trends.

Does PMOS cause insulin resistance, or the other way round?

Unfortunately, there isn’t a straightforward answer. PMOS develops through a combination of genetic factors, hormone signalling and environmental influences. If other people in your family have PMOS, that can influence your development of the condition, and it isn’t something you did or didn’t do. Insulin resistance can be part of that underlying biology rather than something that develops only after weight gain. 

A systematic review and meta-analysis found that women with PMOS had lower insulin sensitivity than women without the condition, independent of their body mass index (BMI).* This supports the idea that PMOS can affect insulin action.

Other factors can influence the development of PMOS and/or insulin resistance. For example, excess body fat, especially around internal organs, can increase the risk of insulin resistance, and high insulin levels can cause your ovaries to produce more male hormones (androgens). Higher androgen levels can contribute to metabolic changes that worsen insulin resistance and increase visceral (belly) fat. Together, these factors create a cycle where they reinforce each other, driving the development of PMOS.**

*Cassar S, et al. (2016). Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic–hyperinsulinaemic clamp studies. 

**Dumesic DA, et al. (2015). Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome.

How high insulin affects hormones

High insulin levels don’t just affect blood sugar. They also encourage your ovaries to produce more androgens, including testosterone. Women naturally produce these hormones, but they become an issue when their levels are excessive. 

Higher insulin levels also lower sex hormone-binding globulin (SHBG), a transport protein that binds sex hormones, including testosterone and oestrogen, and makes them inactive. With less SHBG available, more active testosterone can remain in the bloodstream and act on various tissues.* This contributes to some of the classic PMOS symptoms,** such as:

• Irregular ovulation – your ovaries may release eggs infrequently, leading to unpredictable periods and difficulty conceiving

• Acne – increased androgens can stimulate oily skin, leading to breakouts

• Excess facial or body hair – also known as hirsutism and driven by increased androgens

• Scalp hair thinning – caused by androgen-sensitive follicles producing finer hairs on your head

*Sørensen K, et al. (2009). Sex Hormone–Binding Globulin Levels Predict Insulin Sensitivity, Disposition Index, and Cardiovascular Risk During Puberty.

**Xing C, et al. (2022). Effect of Sex Hormone-Binding Globulin on Polycystic Ovary Syndrome: Mechanisms, Manifestations, Genetics, and Treatment.

How common is it?

Research suggests that 65 to 70% of women with PMOS have insulin resistance.* It’s more common in women with a BMI over 30 (70 to 80%), but it also affects women with a BMI < 25 (20 to 25%).**

The main takeaway is that insulin resistance can occur at any body size. So, having a lower body weight doesn’t remove the need to discuss metabolic health with a clinician, and equally, living with a higher weight doesn’t guarantee that insulin will work less efficiently for you. 

*Chan JL, et al. (2026). Polyendocrine metabolic ovarian syndrome (PMOS)/polycystic ovary syndrome (PCOS): current and future trends.

**Marshall JC, et al. (2013). All Women With PCOS Should Be Treated For Insulin Resistance.

Signs and Symptoms of Insulin Resistance in PMOS

For many people, insulin resistance has very few obvious signs; some people may have no symptoms at all. However, some physical changes can raise suspicion, such as dark, velvety patches of skin, weight gain and skin tags. Although more general PMOS symptoms, such as tiredness, increased cravings and irregular periods, are not reliable signs of PMOS, they also deserve attention.

Physical signs

One of the most recognisable signs of insulin resistance in PMOS is darker, thickened skin patches, usually around the neck, armpits and groin, called acanthosis nigricans. This happens because high insulin levels trigger overgrowth of skin and pigment cells, creating the characteristic dark, velvety patches.

Another key sign can be weight gain, especially around your middle (known as PMOS belly) or difficulty losing weight if you have PMOS. That’s because when your cells don't respond to insulin as they should, your body removes excess glucose from the blood and stores it as fat. Other classic PMOS symptoms, including excess hair growth, scalp thinning and acne, may also be associated with insulin resistance.*

Skin tags can also indicate insulin resistance. They are harmless growths that usually occur in your armpits or on your neck. However, they are also common in people without PMOS and insulin resistance, so they cannot reliably tell you if you have insulin resistance on their own.

Speak to your GP if you have noticed any new or persistent skin changes, weight gain or difficulty losing weight. 

*González-Saldivar G, et al. (2016). Skin Manifestations of Insulin Resistance: From a Biochemical Stance to a Clinical Diagnosis and Management.

How you might feel

Insulin resistance in PMOS may:

• Make you feel more tired or sleepy after a meal

• Increase your cravings for sweet or carbohydrate-rich foods, which may be intense

• Cause hunger to return sooner than expected after eating

• Affect your ability to concentrate, sometimes described as brain fog

• Change your mood or your energy levels

These signs are real, but they are not always the result of insulin resistance. Factors like poor sleep, stress, anaemia, thyroid issues, medication and not eating enough can also cause similar symptoms. Keeping a symptom diary that describes how you feel at certain times of the day can help you start a discussion with your doctor so they can identify the cause.

Symptoms that overlap with PMOS itself

Several insulin resistance symptoms can overlap with PMOS. For example, irregular or absent periods and difficulty getting pregnant can be caused by disrupted ovulation. Although high insulin levels can contribute, PMOS also directly affects ovulation through several pathways. So, while improving insulin sensitivity may help some women, others may need additional treatment to regulate their cycles or support fertility. 

Your symptoms alone cannot confirm insulin resistance. That’s why speaking to a doctor and getting tested for PMOS is crucial to getting the right treatment and support you need.

How Is Insulin Resistance Diagnosed in the UK?

It can be frustrating to be told that results look “normal” when something still feels off. Part of the reason is that there is currently no single routine NHS test that reliably confirms insulin resistance in everyone, so you may need several for a diagnosis.* Your GP will usually ask about your symptoms, medical history and metabolic risk before using blood tests to check how your body handles glucose. 

Some of the tests a clinician can use to confirm insulin resistance include:

*NHS. (2023). Metabolic syndrome.

How to prepare for your appointment

At your appointment, bring a brief record of your periods and symptoms, along with any medications or supplements you take. Let the clinician know if you have a family history of PMOS or type 2 diabetes, or whether you are looking to get pregnant in the future. 

Some of the test-related questions you might like to ask include:

• Which blood sugar test is most appropriate for me?

• Would an oral glucose tolerance test be useful?

• Should we check my cholesterol and blood pressure?

• When should these checks be repeated?

When to see a GP

Arrange an appointment with a GP if you are:

• Unusually thirsty

• Urinating more often 

• Persistently tired

• Losing weight without trying

If you have a family history of type 2 diabetes, you should tell the doctor, even if you feel well. 

If these symptoms occur with vomiting, stomach pain, rapid breathing, marked drowsiness or confusion, seek urgent medical help, and call 111 or 999.

Why Managing Insulin Resistance Matters for Women with PMOS

Managing insulin resistance if you have PMOS goes deeper than just a blood test result. It can help protect your long-term metabolic health and may even improve some hormone-related symptoms. It also lets you check other risk factors before they cause more issues.

Hearing about risk factors can feel worrying, so it helps to know that risk isn’t fixed. Many of them are things you and your clinician can monitor and act on. 

PMOS is associated with increased risk of type 2 diabetes, high blood pressure, cardiovascular disease and non-alcoholic fatty liver disease.* However, your individual risk depends on factors such as family history, blood pressure, cholesterol, smoking and glucose levels, so it is important to monitor these.

PMOS also increases the risk of gestational diabetes, affecting around 40% of pregnancies in women with PMOS.** You should tell your GP or fertility team if you are planning a pregnancy because you may need appropriate glucose testing and pregnancy care.

For fertility, improving your metabolic health may support ovulation because high insulin levels can drive hormone imbalances that can cause irregular menstrual cycles.*** However, irregular ovulation is treatable, and you should not have to manage everything alone before seeking help.  

*NHS. (2026). Polyendocrine metabolic ovarian syndrome (PMOS).

**Quaresima P, et al. Gestational diabetes mellitus and polycystic ovary syndrome, a position statement from EGOI-PCOS. 

***Lei R, et al. (2024). Advances in the study of the correlation between insulin resistance and infertility.

Insulin Resistance and PMOS Treatment and Management

Treatment should fit your health needs, circumstances and priorities. That might mean addressing abnormal glucose levels, supporting regular ovulation, managing acne, or simply finding a sustainable routine. Several approaches can work together, so you do not have to perfect your lifestyle before discussing medication.

Weight management

For some women living with a higher weight, modest weight loss can improve insulin sensitivity and menstrual function. Research suggests that achievable weight loss goals of 5 to 10% of your body weight can improve clinical outcomes, including ovulation rates and menstrual cycle regularity, but responses vary, and weight loss does not cure PMOS.* 

If you want to lose weight, ask your GP for structured support or speak to a Hers clinician for further advice. 

*Cowan S, et al. (2023). Lifestyle management in polycystic ovary syndrome – beyond diet and physical activity.

Medications

Metformin is commonly prescribed off-label for PMOS and it can help with metabolic problems associated with the condition. It reduces liver glucose production, improves your body’s insulin response and, in some women, may also support ovulation or more regular cycles.

Another medication class that may help with insulin resistance in PMOS is glucagon-like peptide-1 (GLP-1) agonists, such as the weight-loss injections Wegovy® and Mounjaro® (the latter also acts on another hormone called GIP). They work by slowing digestion and increasing feelings of fullness to help you lose weight, but they also improve insulin sensitivity, which can make them effective for PMOS.* In the UK, GLP-1s are only approved for weight management and type 2 diabetes, but doctors can prescribe them off-label for PMOS if you meet certain prescribing criteria.

*Bednarz K, et al. (2022). The Role of Glp-1 Receptor Agonists in Insulin Resistance with Concomitant Obesity Treatment in Polycystic Ovary Syndrome. 

Supplements: what does the evidence say?

Supplement marketing can make uncertain findings sound settled. Some products have been studied, but improvements in laboratory markers do not necessarily mean meaningful benefits for symptoms or fertility.

Talk to your pharmacist or GP before starting supplements, particularly if you take glucose-lowering medication or are trying to conceive. Bring the packaging along with you to your appointment so they can check the ingredients and doses.

*Fitz V, et al. (2024). Inositol for Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis to Inform the 2023 Update of the International Evidence-based PCOS Guidelines.

**Kohlhoff G, et al. (2024). The effect of vitamin D supplementation on markers of insulin resistance in women with polycystic ovarian syndrome: a systematic review.

***Ashoush S, et al. (2016). Chromium picolinate reduces insulin resistance in polycystic ovary syndrome: Randomized controlled trial. 

****Szukiewicz D, (2026). Metabolic and Anti-Inflammatory Effects of Berberine—Rationale for Its Therapeutic Potential in Polycystic Ovary Syndrome.

Can You Reverse Insulin Resistance with PMOS?

Insulin resistance can improve, sometimes substantially, in PMOS with the right treatments and lifestyle changes. Whether “reverse” is the right word, however, depends on how you assess it and what happens over time. PMOS itself remains a long-term condition, even when symptoms and metabolic measurements improve.

Focus on improving your health through diet, exercise and medications, if appropriate, as these can improve blood sugar, increase fitness, make cycles more regular and lower long-term health risks.

Progress may not be obvious from how you feel, which is why follow-up matters. Agree with your clinician what you will monitor and when you will review it. If symptoms return or you need medication, that does not mean you have failed. Your treatment needs can change throughout your life.

FAQs

Can you have PMOS without insulin resistance? 

Yes. Insulin resistance is common in PMOS, but not everyone will have it. You can have hormonal changes and irregular ovulation without insulin resistance. Equally, insulin resistance can occur at any body size, so having a lower body weight does not rule it out.

Does insulin resistance cause PMOS hair loss or acne?

Yes. Insulin resistance can contribute to both acne and hair loss in PMOS because increased insulin levels can stimulate your ovaries to produce more androgens, which can worsen acne and hair thinning on your scalp. However, these symptoms can be caused by other factors too and can be present in PMOS even if you do not have insulin resistance.

Will insulin resistance go away if I lose weight?

It depends. Weight loss can improve insulin sensitivity for some women with PMOS, particularly those living with excess body fat, but it does not guarantee that insulin resistance will disappear. PMOS-related insulin resistance can occur independently of weight. Movement, balanced nutrition and prescribed treatment can help, and health benefits are possible even without weight loss.