By Dr. Maria Wong, ND | Women’s Health & Hormone Focussed | Mississauga & Virtual (Ontario-wide)
You’ve been told you have PCOS. Maybe you were handed a diagnosis after an ultrasound showing cystic follicles, or after bloodwork flagged elevated androgens, or simply because your periods have never been regular. Maybe you were put on the pill and sent on your way.
What you may not have been told is this: for the majority of women with PCOS, insulin resistance is not a side effect of the condition – it is one of its central drivers. And if that piece isn’t addressed, managing PCOS symptoms becomes significanetly harder, regardless of what else you try.
This is one of the most important things I discuss with PCOS patients in my Naturopath practice. It’s also one of the most under-explained.
First, what is PCOS actually?
Polycystic ovary syndrome is the most common hormonal condition affecting women of reproductive age, estimated to affect roughly 1 in 10 women. Despite the name, you don’t actually need polycystic ovaries to have PCOS – the diagnosis is based on the Rotterdam criteria, which requires at least two of the following three features:
- Irregular or absent ovulation (which typically causes irregular periods)
- Elevated androgens (male hormones like testosterone) – either on bloodwork or through symptoms like acne, excess hair growth, or hair thinning
- Polycystic ovaries on ultrasound
PCOS is also not one single condition – there are different subtypes, and what drives one woman’s PCOS may not be the same as another’s. This is part of why a one-size-fits-all approach rarely works well.
What is insulin resistance – and why does it matter for PCOS?
Insulin is a hormone produced by the pancreas. Its job is to act like a key – unlocking your cells so they can take in glucose from the bloodstream and use it for energy. When everything is working well, this system is responsive and efficient.
Insulin resistance means the lock has become harder to turn. Your cells stop responding to insulin as effectively, so the pancreas has to produce more and more of it to get the same result. Blood glucose may still look normal on standard testing – but insulin levels are elevated, working overtime behind the scenes.
Here’s where it connects directly to PCOS: elevated insulin directly stimulates the ovaries to produce more androgens – particularly testosterone. It also suppresses a protein called SHBG (sex hormone binding globulin), which normally binds to testosterone and keeps it in check. Less SHBG means more free, active testosterone circulating in the body.
The result is a hormonal environment that drives many of the most frustrating PCOS symptoms: acne, excess facial or body hair, hair thinning at the scalp, irregular ovulation, and difficulty with weight – especially around the midsection.
Why PCOS testing often misses insulin resistance
This is where many women fall through the cracks. The standard test for blood sugar is a fasting glucose – and it can look completely normal even when insulin resistance is well established. That’s because the body is compensating: it’s producing enough extra insulin to keep glucose levels in range, but it’s doing so at a cost.
A fasting insulin level, or better yet a fasting glucose-to-insulin ratio, gives a much clearer picture. An HbA1c (three-month average blood sugar) can also be helpful, though it too can appear normal in the early stages of insulin resistance.
In my practice, I routinely include a blood test called the “2 hour insulin glucose challenge” alongside the standard PCOS bloodwork – because if we don’t look for it, we won’t find it, and we’ll be treating symptoms without addressing the underlying driver.
Signs that insulin resistance may be part of your PCOS picture
Not all PCOS is driven by insulin resistance, but these signs suggest it may be playing a role for you:
- Weight gain that concentrates around the abdomen, or difficulty losing weight despite genuine effort
- Strong carbohydrate cravings, particularly in the afternoon or after meals
- Energy crashes after eating – feeling sleepy or foggy within an hour or two of a meal
- Skin tags or darkening of skin in the folds of the neck, underarms, or groin (called acanthosis nigricans)
- A family history of type 2 diabetes or metabolic syndrome
- Worsening PCOS symptoms after periods of high stress, poor sleep, or dietary changes
If several of these resonate, it’s worth investigating – not because it changes your diagnosis, but because it changes how we approach treatment.
What can actually be done about it?
The good news is that insulin resistance is highly responsive to intervention – often more so than people expect. The approach I use in practice typically includes a combination of the following, tailored to the individual:
Dietary changes that actually make sense for PCOS and insulin resistance
This doesn’t mean a crash diet or cutting carbohydrates entirely. It means choosing carbohydrates that produce a slower, steadier insulin response – higher fibre, less refined, paired with adequate protein and fat. Meal timing and composition matter more than calorie counting for most PCOS patients.
I’m also careful here not to prescribe approaches that create an unhealthy relationship with food. PCOS already carries a higher risk of disordered eating patterns, and any dietary strategy needs to be sustainable and non-restrictive in spirit.
Movement – especially after meals
Exercise improves insulin sensitivity independently of weight loss – meaning you don’t have to lose weight first for it to work. Even a 10 to 15 minute walk after a meal has been shown to meaningfully blunt the post-meal insulin spike. Resistance training is particularly effective for improving muscle insulin sensitivity over time.
Targeted supplementation
Several nutrients and botanicals have good evidence for improving insulin sensitivity in PCOS specifically:
- Inositol
- Berberine
- Magnesium
- N-acetyl cysteine (NAC)
I want to be clear: supplementation works best as part of a broader strategy, not as a standalone fix. Dosing, form, and combinations matter – this isn’t an area where more is always better, and some supplements interact with medications or should not be taken long term without supervision. A conversation with a practitioner before starting is absolutely a must.
Sleep and stress – the overlooked drivers
Poor sleep and chronic stress both directly worsen insulin resistance through cortisol and other stress hormones. This is one reason why PCOS can feel like it cycles through better and worse periods – it often tracks with life stress and sleep quality. Addressing these isn’t just good general advice; for PCOS, it’s part of the clinical picture.
When to consider medication
For some women, particularly those with significant insulin resistance or who are trying to conceive and struggling with ovulation, metformin or other pharmaceutical options are a reasonable part of the plan. Naturopathic and conventional approaches are not mutually exclusive – I work alongside your GP or specialist, not instead of them.
The bigger picture: PCOS as a long-term health consideration
PCOS is not just a fertility or period problem. Untreated insulin resistance in PCOS is associated with a higher long-term risk of type 2 diabetes, cardiovascular disease, and metabolic syndrome. This is not meant to alarm – it’s meant to underscore why addressing it matters beyond symptom management.
Women with PCOS who address insulin resistance early – through lifestyle, supplementation, or medication where appropriate – significantly reduce these long-term risks. This is one of the most meaningful things you can do for your future health, and it’s entirely within reach.
Working with a naturopath for PCOS
If you’ve been diagnosed with PCOS and feel like the underlying picture hasn’t been fully explored – or if you’ve been managing symptoms without much success – a comprehensive naturopathic assessment can help fill in the gaps.
My approach to PCOS starts with proper lab work (including fasting insulin and a full hormone panel), a detailed look at your health history and symptoms, and a treatment plan that addresses what’s actually driving your individual presentation – not just the diagnosis on paper.
I see patients in-person in Mississauga and virtually for anyone in Ontario. If you’d like to learn more before booking, I also offer a free 15-minute meet and greet.
Book your appointment here – in-person (Mississauga) or virtual (anywhere in Ontario).
About Dr. Maria Wong, ND
Dr. Maria Wong is a naturopathic doctor practicing in Mississauga, Ontario, with a focus in women’s hormonal health – including PCOS, perimenopause, endometriosis, fertility, and PMS. She sees patients in-person in Mississauga and virtually for patients across Ontario. She is licensed by the College of Naturopaths of Ontario.
