The Relationship Between PCOS, Insulin Resistance, and Anxiety

Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects many women of reproductive age. It’s characterized by irregular periods, high levels of androgens (male hormones), and polycystic ovaries. Women with PCOS may also experience insulin resistance, which can lead to diabetes, weight gain, and other health problems.

PCOS affects approximately 8 to 13 percent of women of reproductive age, or around five million people in the United States alone. It impacts how often a woman ovulates or when the ovaries release an egg (fertilization). A woman can have PCOS regardless of the presence or absence of cysts on her ovaries.

Research suggests there may be a link between PCOS, insulin resistance, and anxiety, with women with PCOS being more likely to experience anxiety and depression than women without the condition.

Some studies suggest that this may be due to the hormonal imbalances caused by PCOS, while others point to the physical effects of insulin resistance on the body.

Understanding Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects women of reproductive age. PCOS is characterized by the presence of multiple cysts on the ovaries, which can lead to irregular menstrual cycles, infertility, and other health issues.


The exact cause of PCOS is unknown, but it’s believed to be a combination of genetic and environmental factors. Insulin resistance, which is a condition in which the body's cells do not respond properly to insulin, is thought to play a role in the development of PCOS.


The symptoms of PCOS can vary from woman to woman, but they typically include irregular menstrual cycles, on-and-off menstrual flow, acne, weight gain, and excess hair growth. Women with PCOS may also experience infertility, depression, and anxiety.


Diagnosing PCOS can be challenging because there’s no single test that can definitively diagnose the condition. Instead, doctors typically rely on a combination of medical history, physical exam, and laboratory tests to make a diagnosis.

PCOS and Insulin Resistance

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age. One of the key features of PCOS is insulin resistance, which is a condition where the body's cells become less responsive to insulin. Insulin resistance can lead to an increase in insulin levels in the blood, a condition known as hyperinsulinemia or insulinemia.

Insulin is a hormone produced by the pancreas that helps regulate blood sugar levels. It helps the body's cells absorb glucose from the blood to use as energy. When the body becomes resistant to insulin, the pancreas produces more insulin to compensate. This can lead to a vicious cycle of increasing insulin levels and worsening insulin resistance.

The exact pathogenesis of insulin resistance in PCOS is not fully understood. However, it’s believed that several factors contribute to its development.

One of these factors is the increased production of androgens, which are male hormones that are also produced in women's bodies. Androgens can interfere with insulin signaling and contribute to insulin resistance.

Insulin resistance in PCOS is also associated with a specific metabolic profile. Women with PCOS and insulin resistance are more likely to have high levels of triglycerides, low levels of high-density lipoprotein (HDL) cholesterol, and increased levels of inflammatory markers such as C-reactive protein (CRP).

Insulin resistance in PCOS can also increase the risk of developing type 2 diabetes. Women with PCOS are already at an increased risk of developing diabetes due to their metabolic profile, and insulin resistance further increases this risk.

Anxiety and PCOS

Women with PCOS are at an increased risk of developing anxiety disorders compared to women without PCOS. The exact mechanisms underlying this association are not yet fully understood.

Research suggests that anxiety in women with PCOS may be related to their hormonal imbalances. PCOS is characterized by elevated levels of androgens, which are male sex hormones that are also present in females.

High levels of androgens in women with PCOS can lead to symptoms like acne, weight gain, and hair loss. These symptoms can impact a woman's self-esteem and contribute to poor mental wellbeing.  

In addition to hormonal imbalances, women with PCOS may also be at risk for anxiety due to insulin resistance, as described in the previous section. Insulin resistance can lead to high blood sugar levels. This can cause inflammation in the body, which has been linked to anxiety and depression.

Women with PCOS and anxiety may have more difficulty managing their symptoms and adhering to treatment plans. Anxiety can also make it harder to maintain habits that promote mental wellbeing, such as exercising regularly and eating a balanced diet.

It’s important for women with PCOS to be aware of the increased risk for anxiety and to seek appropriate treatment if necessary. Treatment options include medication, therapy, and lifestyle changes. By addressing anxiety, women with PCOS can improve their overall quality of life and better manage their symptoms.

Physical Manifestations of PCOS

PCOS is a complex disorder that affects many aspects of a woman's physical health. The most common physical manifestations of PCOS include obesity, weight gain, acne, hyperandrogenism, anovulation, and ovarian cysts.

Obesity and weight gain are common symptoms of PCOS, affecting up to 80% of women with the condition. This is due to the hormonal imbalances that occur in PCOS, which can cause insulin resistance and make it difficult for the body to process glucose properly.

Insulin resistance can lead to weight gain, particularly in the abdominal area, which can increase the risk of other health problems such as diabetes and heart disease.

Acne is another common symptom of PCOS, affecting up to 70% of women with the condition. This is due to the excess androgen hormones that are produced in PCOS, which can cause the sebaceous glands in the skin to produce more oil, leading to acne breakouts.

Hyperandrogenism is a key feature of PCOS, and it can cause a range of physical symptoms, including excess hair growth (hirsutism), male pattern baldness, and acne. This is due to the excess androgen hormones that are produced in PCOS, which can cause these physical changes.

Anovulation is another common symptom of PCOS, affecting up to 70% of women with the condition. This is due to the hormonal imbalances that occur in PCOS, which can disrupt the ovulation process and cause irregular periods.

Ovarian cysts are a common feature of PCOS, with up to 20% of women with the condition developing cysts on their ovaries. These cysts are usually small and benign, but they can cause pain and discomfort, particularly during ovulation.

Treatment and Management of PCOS

PCOS is a chronic condition that requires lifelong management. Treatment of PCOS aims to alleviate symptoms, prevent complications, and improve overall quality of life. The treatment approach varies depending on the patient's individual needs, medical history, and severity of symptoms.

Lifestyle Modification

Lifestyle modification is an essential component of PCOS management. It involves making healthy lifestyle changes to improve overall health and reduce symptoms. Lifestyle modifications that may help manage PCOS include:

  • Regular exercise. Exercise can help improve insulin sensitivity, reduce weight, and improve overall health. It is recommended to engage in moderate-intensity exercise for at least 150 minutes per week.
  • Weight management. Maintaining a healthy weight is important in managing PCOS symptoms. Weight loss can improve insulin sensitivity, reduce androgen levels, and improve menstrual regularity.
  • Stress management. Stress can exacerbate PCOS symptoms. Stress management interventions, such as yoga, meditation, or self-help tools, may help reduce stress and improve symptoms.


Medication is often prescribed to manage PCOS symptoms. The choice of medication depends on the patient's symptoms and medical history. Common medications used to manage PCOS include:

  • Birth control pills. Birth control pills can help regulate menstrual cycles, reduce androgen levels, and improve acne.
  • Metformin is a medication used to improve insulin sensitivity and reduce androgen levels. It may be prescribed to help manage PCOS symptoms, particularly in patients with insulin resistance.
  • Anti-androgen medications. Anti-androgen medications, such as spironolactone, can help reduce androgen levels and improve acne and hirsutism.


Dietary changes may be recommended to manage PCOS symptoms. A healthy diet can help improve insulin sensitivity, promote weight loss, and reduce inflammation.

A diet rich in whole grains, fruits, vegetables, and lean proteins is recommended. It’s also recommended to limit processed foods, sugary drinks, and saturated fats.


Polycystic Ovary Syndrome (PCOS) is linked to insulin resistance, where the body's cells don't respond properly to insulin, causing elevated blood sugar. PCOS is associated with increased anxiety in women due to hormonal imbalances and the challenges of managing its symptoms.

While the precise mechanisms connecting PCOS, insulin resistance, and anxiety require further research, understanding these connections is vital for more effective treatment and support for women dealing with this complex and often distressing condition.

Treatment of PCOS can involve a combination of lifestyle modifications, medication and dietary changes. The treatment approach should be individualized based on the person’s symptoms and medical history.

People with PCOS should consult with a multidisciplinary team of healthcare professionals to receive comprehensive and specialized care. This can include gynaecologists (specializing in women’s reproductive health), endocrinologists (specializing in hormonal imbalances), and dermatologists (skin specialists).

Self-Guided Support for Anxiety and Low Mood

Research shows that self-help materials are often enough for people to overcome mild to moderate mental health difficulties without professional support.

If you’re interested in a self-guided program that includes tools from CBT, DBT, ACT and more, be sure to check out The Mental Wellbeing Toolkit. It's "like 10 therapy sessions in one."

The Mental Wellbeing Toolkit


About Rebecca

Rebecca is the founder of The Wellness Society and author of two fluff-free books, The Framework and Understanding and Healing Trauma.

She's passionate about creating concise and compassionate mental health and wellbeing tools that address the root causes of distress.

Read more about her views on our About page.