EXPLORING THE LINK BETWEEN POLYCYSTIC OVARY SYNDROME (PCOS) AND INSULIN RESISTANCE IN WOMEN OF REPRODUCTIVE AGE

Abstract

Background

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age and is frequently associated with metabolic disturbances. Insulin resistance plays a central role in the development and progression of PCOS, yet it often remains under-recognized in routine clinical practice. In Pakistan, limited local data exist regarding the burden of insulin resistance among women with PCOS attending tertiary care hospitals.

Objective

To study the relationship between insulin resistance and the development of PCOS in women during their reproductive years.

Methods

This cross-sectional observational study was conducted in the gynecology and endocrinology outpatient departments of a tertiary hospital in Karachi. Women aged 15–45 years diagnosed with PCOS according to the Rotterdam criteria were included. Demographic data, anthropometric measurements (BMI and waist circumference), clinical features (menstrual irregularity, hirsutism, acne, and acanthosis nigricans), and laboratory parameters were recorded. Fasting plasma glucose and fasting serum insulin levels were measured after an overnight fast, and insulin resistance was assessed using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Statistical analysis was performed to determine associations between HOMA-IR and clinical or anthropometric variables. A p-value <0.05 was considered statistically significant.

Study Type: Observational study

Results

A substantial proportion of women with PCOS demonstrated elevated HOMA-IR values, indicating a high prevalence of insulin resistance in this population. Although most participants had fasting glucose within the normal or borderline range, fasting insulin levels were frequently raised. Higher BMI and increased waist circumference showed a positive association with HOMA-IR values. Clinical markers such as acanthosis nigricans were more common in women with greater insulin resistance. Menstrual irregularities and hyperandrogenic features also tended to cluster with higher metabolic burden. Differences in insulin resistance were observed across PCOS phenotypes, with certain phenotypes demonstrating greater metabolic involvement.

Conclusion

Insulin resistance is highly prevalent among women with PCOS attending tertiary care in Karachi and is closely linked with both anthropometric measures and clinical manifestations. Normal fasting glucose levels do not exclude underlying metabolic dysfunction. Early metabolic screening, combined with integrated reproductive and metabolic management, is essential to reduce long-term health risks in this population.