From the Guidelines
Women with PCOS and normal fasting insulin levels should still be monitored regularly for insulin resistance and receive lifestyle modification recommendations, including a balanced diet and regular exercise, as insulin resistance can develop over time. According to the American College of Obstetricians and Gynecologists (ACOG) guidelines 1, the management of PCOS often involves the use of combination oral contraceptive pills, which can help suppress androgen secretion and increase circulating sex hormone binding globulin levels. Additionally, medications like metformin, an insulin-sensitizing agent, may be prescribed to improve insulin sensitivity and reduce the risk of metabolic complications, even in women with normal fasting insulin levels. Some key points to consider in the management of PCOS with normal fasting insulin levels include:
- Regular monitoring of insulin levels and glucose tolerance to detect any changes or development of insulin resistance
- Lifestyle modifications, such as:
- Regular exercise (at least 150 minutes of moderate activity weekly)
- A balanced diet rich in fiber and low in refined carbohydrates
- Maintaining a healthy weight
- Consideration of medications like metformin (500-2000 mg daily) to improve insulin sensitivity and reduce the risk of metabolic complications, even in the presence of normal fasting insulin levels. Insulin resistance in PCOS can lead to a range of symptoms, including irregular periods, excess androgen production, and metabolic complications, making regular monitoring and management essential to prevent long-term morbidity and mortality.
From the Research
PCOS and Normal Fasting Insulin
- PCOS is a common endocrine disorder among women of reproductive age, characterized by hyperandrogenism, anovulation, and polycystic ovaries 2.
- Women with PCOS often have insulin resistance and hyperinsulinemia, which can lead to metabolic complications such as dyslipidaemia, obesity, and glucose tolerance 3.
- Elevated fasting insulin is associated with cardiovascular and metabolic risk in women with PCOS, and is an important determinant in the pathogenesis of obesity and hyperandrogenism in PCOS 4.
- However, some studies suggest that lifestyle modifications, such as dietary changes and physical activity, can improve insulin sensitivity and hormonal balance in women with PCOS, even with normal fasting insulin levels 2.
- Additionally, certain forms of fasting, such as intermittent fasting, may have beneficial effects on ovarian function, androgen excess, and infertility in PCOS women by reducing insulin levels and improving insulin sensitivity 5.
Insulin Sensitivity and PCOS
- Insulin sensitivity is improved with dietary interventions such as foods with low glycemic index scores, caloric restrictions, and high-fiber diets 2.
- Physical activity, such as aerobic and resistance exercise, also enhances insulin sensitivity and helps with weight loss and metabolic outcomes in women with PCOS 2.
- Metformin, an insulin-sensitizing drug, is often used as an adjuvant therapy to lifestyle modification in patients with insulin resistance and impaired glucose tolerance, as well as in those referred to infertility treatment 3.
- The anti-Mullerian hormone (AMH) may be a useful biomarker for evaluating the effectiveness of metformin therapy in PCOS patients, as reductions in AMH levels are associated with improved insulin sensitivity and ovarian function 6.