· By Amy Suzanne Upchurch, Founder + CEO of Pink Stork, Certified Health Coach, INHC
Can you have insulin resistance with PCOS (PMOS) if you are not overweight?
Yes. Insulin resistance affects an estimated 35 to 80 percent of women with polyendocrine metabolic ovarian syndrome, formerly known as PCOS, and this range holds even when body weight is accounted for.1 Research has documented metabolic disturbances and glucose intolerance specifically in lean women with the condition, which means body size alone does not tell you whether insulin resistance is part of your picture.2
The "PCOS only affects overweight women" myth
It is a common assumption, and an inaccurate one. Insulin resistance is a core feature of PCOS/PMOS itself, not a separate issue caused only by excess weight. Studies estimating its prevalence at 35 to 80 percent among women with the condition consistently find that this range does not disappear once body weight is factored into the analysis.1 If a provider has dismissed your symptoms because you are not overweight, that dismissal is not supported by the research.
What insulin resistance actually looks like in lean PCOS/PMOS
Research specifically focused on lean women with this condition has documented metabolic disturbances, including glucose intolerance, that mirror what is seen in women with higher body weight and the condition.2 This indicates the condition itself, not excess weight, can independently drive insulin resistance, which supports the case for metabolic screening based on diagnosis rather than on body mass index alone.
"Your size has never been the whole story of your health. God made every body differently, and true wellness looks different for every woman."
— Amy Suzanne Upchurch, Founder and CEO of Pink Stork
"If we get you to a healthy and optimal place, the weight will be what it needs to be."
— Dr. Samantha Ess, ND, Naturopathic Doctor specializing in hormone health and fertility
Why this matters for long-term health, not just weight
Insulin resistance is not only a metabolic footnote. A systematic review and meta-analysis conducted for the 2023 International Evidence-Based PCOS Guideline Update found that women with this condition face meaningfully elevated risk of clinical cardiovascular disease events compared with women without it.3 That risk is tied to the condition's underlying metabolic features, which is exactly why insulin resistance deserves attention regardless of what a scale says.
What providers should be checking regardless of body size
A thorough metabolic evaluation for PCOS/PMOS generally includes:
- Fasting glucose and fasting insulin, sometimes combined into a HOMA-IR calculation.
- A lipid panel to assess cardiovascular risk factors.
- Blood pressure monitoring.
- A conversation about family history of type 2 diabetes and heart disease.
Mayo Clinic notes that management of this condition typically includes addressing metabolic risk factors as part of a comprehensive treatment plan, not only cycle-related symptoms.4 If your workup has never included these markers and you have this diagnosis, it is reasonable to ask your provider directly why not, and to request them regardless of your current weight.
Frequently asked questions
Can you have insulin resistance without being diabetic or prediabetic?
Yes. Insulin resistance can be present well before glucose levels rise enough to meet the criteria for prediabetes or type 2 diabetes, which is exactly why fasting insulin and HOMA-IR are useful alongside fasting glucose.
Does losing weight fix insulin resistance in PCOS/PMOS?
Weight change can improve insulin sensitivity for some people, but insulin resistance is a feature of the condition itself, not solely a consequence of body weight, so it can persist or return even with weight changes.
Why hasn't my provider mentioned insulin resistance if I'm not overweight?
Some providers still associate insulin resistance primarily with higher body weight, even though the research shows it affects lean women with this condition at meaningful rates too. It is worth raising directly if it has not come up.
What tests should I ask for?
Fasting glucose, fasting insulin or a HOMA-IR calculation, and a lipid panel are reasonable starting points, along with blood pressure monitoring and a family health history discussion.
Is this connected to fertility as well?
Yes. Insulin resistance and ovulatory function are closely linked in this condition. See what the fertility research actually shows here.
Read more on why PCOS was renamed PMOS, or continue with how ovulation and fertility work with this condition.
This article is for general educational purposes and is not a substitute for personalized medical advice. Ask your healthcare provider whether metabolic screening is appropriate for your individual situation.
