INSULIN RESISTANCE IN POLYCYSTIC OVARY SYNDROME — A NARRATIVE REVIEW OF MECHANISMS AND MANAGEMENT

Yuliia Dubova; Iia Zhaharina; Yaryna Manila; Aleksandra Kłuś; Aneta Kasperska; Łukasz Kobiałkowski; Hanna Markowska; Alina Biletska; Martyna Sienicka; Valery Doroshkov

doi:10.31435/ijitss.3(51).2026.6176

Authors

Yuliia Dubova Wojewódzki Szpital Specjalistyczny im. Janusza Korczaka w Słupsku, Słupsk, Poland https://orcid.org/0009-0007-9431-4439
Iia Zhaharina University Clinical Hospital No.2 of Pomeranian Medical University in Szczecin, Szczecin, Poland https://orcid.org/0009-0009-4633-3875
Yaryna Manila University Clinical Hospital in Krakow, ul. Marii Orwid 1, 30-688 Kraków, Poland https://orcid.org/0009-0008-2002-3863
Aleksandra Kłuś Silesian Rheumatology Center Gen. Jerzy Ziętek in Ustroń, Poland https://orcid.org/0009-0009-7419-2897
Aneta Kasperska Mazovian Bródno Hospital in Warsaw, Warsaw, Poland https://orcid.org/0009-0002-7585-3414
Łukasz Kobiałkowski Poznan University of Medical Sciences, Fredry 10, 61-701 Poznań, Poland https://orcid.org/0009-0009-9603-5585
Hanna Markowska Samodzielny Publiczny Wielospecjalistyczny Zakład Opieki Zdrowotnej Ministerstwa Spraw Wewnętrznych i Administracji w Bydgoszczy, Poland https://orcid.org/0009-0006-7837-1989
Alina Biletska Wojewódzki Szpital Specjalistyczny im. Janusza Korczaka w Słupsku, Słupsk, Poland https://orcid.org/0009-0009-9090-2721
Martyna Sienicka Instytut „Centrum Zdrowia Matki Polki" w Łodzi, Poland https://orcid.org/0009-0009-8164-6236
Valery Doroshkov University Clinical Hospital No.2 of Pomeranian Medical University in Szczecin, Szczecin, Poland https://orcid.org/0009-0009-6163-2179

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6176

Keywords:

Polycystic Ovary Syndrome; Insulin Resistance; Hyperandrogenism; Metformin; Inositol; GLP-1 Receptor Agonists

Abstract

Polycystic ovary syndrome (PCOS) affects 11–13% of women of reproductive age worldwide and combines hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology. Once viewed as a purely reproductive disorder, PCOS is now also recognised as a metabolic one, with insulin resistance (IR) and compensatory hyperinsulinaemia linking its reproductive and metabolic features. In a 2026 international consensus published in The Lancet, the condition was formally renamed polyendocrine metabolic ovarian syndrome (PMOS); the term PCOS remains widely used during the announced three-year transition period. This narrative review synthesises current evidence on the role of insulin resistance in the pathophysiology of PCOS, with a focus on the 2023 International Evidence-based Guideline and recent pharmacological developments. We searched PubMed, Scopus and Google Scholar for peer-reviewed literature published in English between January 2004 and April 2026, prioritising original studies, systematic reviews, meta-analyses and current clinical guidelines. Hyperinsulinaemia stimulates ovarian theca-cell androgen production and lowers hepatic sex hormone-binding globulin synthesis, raising bioavailable androgens. A pathway-selective insulin signalling defect — impaired PI3K/Akt with relatively preserved MAPK signalling — has been proposed as a unifying molecular mechanism. Lifestyle modification remains first-line therapy; metformin and inositol improve metabolic and ovulatory parameters, and glucagon-like peptide-1 receptor agonists produce greater reductions in body weight and HOMA-IR than metformin in head-to-head studies. Insulin resistance is a key driver of both reproductive and metabolic outcomes, and early identification is essential for reducing long-term cardiometabolic morbidity.

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