Insulin resistance is much more common than many people think, and it can affect women in unexpected and very undesirable ways. Insulin resistance is found in approximately 15% of Americans, but it is found in up to 90% of women with polycystic ovary syndrome (PCOS). If not corrected, the stress insulin resistance causes on the pancreas leads to a decline in pancreatic function, resulting in Type 2 diabetes. Insulin resistance can cause symptoms ranging from fatigue to infertility. Most women don’t have any symptoms of insulin resistance, or they can be subtle symptoms like fatigue, carbohydrate cravings, and weight gain around the waistline. If it continues, diabetes will result, which exhibits signs like excessive thirst, frequent urination, darkening skin in skin folds, and worsening fatigue. Diabetes puts women at risk for high cholesterol, heart disease, stroke, kidney disease, eye problems, and nerve damage. But these consequences can be avoided if the insulin resistance is treated in time.
What is insulin resistance?
To understand how to prevent or cure insulin resistance, we need to first understand insulin. Insulin is a hormone produced by the pancreas in response to eating sugar or carbohydrates, which are then broken down into glucose. Insulin will then direct the glucose into our cells, mainly to our muscles, liver, and fat, in order to provide energy. Insulin also plays a role in our satiety center in our brain, which tells us when to feel full or hungry.
Insulin resistance occurs when our cells become less sensitive to the actions of insulin. This results in an increase in concentration of insulin, fat, and sugar in the blood. Not only does this increase blood sugar (leading to diabetes) but it also increases cholesterol. The lack of proper glucose utilization results in fatigue and abdominal fat production. In addition, the high insulin levels result in cravings and overeating, further leading to weight gain. For women, these imbalances, if unaddressed, can be extremely harmful to her fertility.
How insulin resistance can affect fertility
In women, an increased insulin level alters levels of GnRH, LH, and FSH, which are all important reproductive hormones. These abnormalities result in a decreased rate of ovulation, making pregnancy difficult to achieve for women with this condition. The high insulin also causes an increase in testosterone production. High testosterone not only causes facial, chest, and abdominal hair (hirsutism), but also leads to the formation of multiple follicular cysts which increase estrogen production. The imbalance among various hormones that inhibits the normal fluctuation in estrogen levels causes a delay in ovulation and irregular cycles. In severe insulin resistance, women can stop ovulating all together (which is known as anovulation) and become infertile.
In addition, the lack of regular periods builds up the endometrial lining of the uterus. Without being shed at least every three months, there is a risk of endometrial cancer. Insulin resistance is also a precursor to gestational diabetes (diabetes in pregnancy resulting in a much higher risk of a large, unhealthy baby). Last, but certainly not least, insulin resistance is a major contributor of inflammation. Chronic inflammation has been linked to infertility, dementia, autoimmune disorders, arthritis, irritable bowel syndrome, psoriasis, migraines, asthma, cancer, osteoporosis, cardiovascular disease, and depression.
If a woman is charting her cycles with a mucus fertility awareness method, she may see excessive inflammatory-type mucus all cycle long, indicative of the ongoing inflammation in her body. She may also observe long follicular phases, resulting in long and irregular cycles, due to the delay in ovulation. I also commonly see a deficiency of fertile cervical mucus due to the decrease in FSH, resulting in the decrease of estrogen stimulating the cervical crypts.
The connection between PCOS and insulin resistance
Insulin resistance and polycystic ovary syndrome (PCOS) often go hand-in-hand. A mainstream treatment for PCOS is hormonal birth control or other artificial hormones. Unfortunately, if a woman has insulin resistance, hormonal birth control can further increase her cholesterol levels, (increasing the risk of heart disease and stroke), exacerbate estrogen dominance (increasing the risk of cancer), and increase her risk of depression.
Thankfully, there are safe, effective alternatives to birth control that can help women and their doctors identify and treat PCOS without exacerbating insulin resistance. When a woman with irregular cycles learns to chart her cycle with a Fertility Awareness Method (FAM), the biomarkers of insulin resistance can be seen on her menstrual cycle chart. Long, irregular cycles, with poor cervical mucus production (low estrogen), tail-end brown bleeding (inflammation), and breakthrough spotting (endometrial lining build-up) will all point to the underlying cause, which will help you seek proper treatment. A doctor trained in fertility awareness can assist a patient in diagnosis and treatment.
How fertility awareness can help manage insulin resistance, diabetes
Fertility awareness charting can also be a pivotal tool if the pancreas does fail, resulting in diabetes. Read Ginie Kay’s experience of living with Type 1 diabetes, and the healing that fertility awareness has helped her achieve:
“[FAM] Charting helped me establish a timeline of my health decline and track how my fertility ceased and recovered once I began insulin therapy. Knowing if and when ovulation occurs became an advantage for me, equipping me to adjust my treatment decisions, even to reverse excruciating neuropathy. I found charting for health to be beneficial, not only for wellness or illness confirmation but for tracking recovery.”
In another article for Natural Womanhood, Ginie Kay explains how her FAM chart helps her tailor her insulin treatments and restore a manageable way of life without synthetic hormones:
“The juxtaposition of Sympto-Thermal [FAM charting] data with glucose trends allows me to detect surges in hormones giving me a heads-up regarding shifts in insulin response. Knowing why and when my insulin sensitivity shifts has been a game-changer for my Type 1 Diabetes by achieving flatter glucose curves and reducing stress associated with glucose excursions.”
Diagnosing and treating insulin resistance
As a Physician Assistant and Health Educator with more than 20 years of experience in OB/GYN and fertility, with specialties in NaproTechnology and Fertility Education and Medical Management (FEMM), I highly recommend getting tested to see if you have insulin resistance if you:
- see biomarkers indicative of it within your fertility charts
- have been diagnosed with PCOS
- have a history of Gestational Diabetes
- have a strong family history of diabetes
Testing
The test for insulin resistance is performed via an oral glucose tolerance test (OGTT), testing for insulin and glucose levels. Insulin levels should not be tested by just one blood draw. To be thorough, insulin levels must be tested four times in a two-hour period, first fasting, and then serially after drinking Glucola. Elevated insulin levels will give a diagnosis of insulin resistance, while elevated glucose levels will diagnose diabetes or pre-diabetes (along with another test, hemoglobin A1c).
Dietary changes
Dietary change is the most important treatment for insulin resistance. The more sugar in one’s diet, the worse the insulin resistance will be. A diet extremely low in sugar and carbs will be very beneficial to sensitize insulin receptors and to lower insulin and glucose levels. Two diet plans that can be beneficial in this goal are the Paleo and Keto diets. It is recommended to consult a nutritionist to find out which diet plan is best for you, and to receive individualized instruction.
Medical treatment
There are several options for the medical treatment of insulin resistance. Metformin has been long proven to decrease insulin resistance and decrease the risk of diabetes. However, it does come with side effects; approximately 60% of women develop abdominal cramping or diarrhea while on metformin. To limit these side effects, it is recommended to start with a low dose, and increase the dosage very gradually.
Natural supplements
There are also natural supplement options to treat insulin resistance. Inositol (a natural sugar), especially in the formulation of Myo-Inositol and D-Chiro Inositol (in a 40:1 ratio), has been proven in small studies to be equivalent to the effectiveness of metformin, without the side effects. Berberine (an herbal compound), is another option that can decrease insulin resistance, especially in the presence of high cholesterol, high blood sugar, or gut problems. You should always consult with your doctor before starting any new supplements.
If you suspect you may have insulin resistance, it is imperative to find a knowledgeable provider; one who seeks to find the underlying causes of your dysfunction and to address it, rather than cover up your symptoms. The steps you take today could prevent a lifetime of trouble.
Additional Reading
How Whole30 Helped Me Manage my PCOS and Overcome Infertility
How to Solve Period Issues without the Pill
3 Simple Nutrition Tips that Will Improve Your Reproductive Health
