Polyendocrine Metabolic Ovarian Syndrome (PMOS, formerly PCOS) is one of the most common endocrine disorders in women of reproductive age, affecting approximately 1 in 10 women worldwide. Although the syndrome is traditionally associated with the reproductive system (irregular menstrual cycles, polycystic ovarian morphology), the endocrine and metabolic background of patients is often left on the sidelines. Insulin resistance is one of the most common metabolic disorders and represents a significant feature of patients with this condition.
What Is Insulin Resistance?
Insulin is the hormone that allows the body's cells to absorb glucose from the blood and use it as energy. When cells "resist" insulin, the pancreas is forced to produce increasingly larger amounts to maintain normal blood sugar levels. The result is a state of chronic hyperinsulinemia, which affects not only metabolism but also ovarian function. Insulin resistance also occurs regardless of body weight. It can be present in women with a high, normal, or low Body Mass Index (BMI).
How Does Insulin Resistance Affect the Ovaries?
Elevated insulin levels in the blood act directly on the ovaries, stimulating increased production of androgens, such as testosterone, which can lead to acne and hirsutism. At the same time, this hormonal imbalance disrupts the menstrual cycle, leading to irregular cycles or cycles without ovulation. It also affects egg quality by contributing to the formation of multiple small follicles that fail to mature normally. These factors can make natural conception more difficult and reduce success rates in assisted reproduction cycles. Therefore, addressing insulin resistance before and during treatment in women undergoing assisted reproduction therapies is very important and can positively affect treatment outcomes.
Specifically, it can improve:
- Ovarian response to medical stimulation
- Increase implantation rates
- Improve egg and embryo quality
- Reduce the risk of complications such as Ovarian Hyperstimulation Syndrome
For this reason, nutritional intervention is often an integral part of the treatment plan, alongside medical monitoring.
Practical Nutritional Strategies
Certain sustainable dietary changes can bring positive results in managing insulin resistance:
1. Preference for low glycemic index foods: Consuming foods such as legumes, whole grain products, and vegetables instead of processed carbohydrates and sugar helps stabilize blood sugar levels.
2. Combining macronutrients at every meal: Combining carbohydrates with protein, healthy fats, and fiber at each meal slows glucose absorption and reduces sharp fluctuations of insulin.
3. Regular meals: Avoiding prolonged periods of fasting or consuming large, irregular meals helps maintain stable blood sugar and insulin levels.
4. Physical activity: Increasing physical activity, particularly combining aerobic exercise with strength training, can improve cellular insulin sensitivity even without weight loss.
5. Dietary supplements: The use of inositol, specifically the combination of myo-inositol/D-chiro-inositol, is one of the most well studied supplementary interventions in PMOS, as it contributes to improved insulin sensitivity and improved egg quality.
Insulin resistance may play a central role in PMOS (formerly PCOS) and be the main factor behind many of the syndrome’s symptoms and fertility challenges. Early diagnosis, along with appropriate nutritional and medical intervention, can be a decisive factor in improving outcomes, whether for natural conception or for assisted reproductive therapies.
Artemis Kyrka, BSc, MSc, RD
Artemis is a registered dietitian and collaborates with Newlife IVF as a Fertility & Women's Health Dietitian.
