Editorial reviews. Affiliate fees from some providers don't affect rankings. Disclosure

No advertiser influenceAffiliate fees disclosedReviewed by board-certified clinicians

PCOS · Updated 2026-05-17

Insulin resistance in PCOS: testing and treatment

Written byEditorial Team, HormonalHealth PortalReviewed byEditorial Medical Review, MD, NAMS-CMP· Updated May 17, 2026

Short answer: Fasting insulin >10 µIU/mL, HOMA-IR >2.5, or OGTT with 2-hour insulin >75. Phenotype A (full Rotterdam) has highest IR rates — 70-95%.

1 min read

Key takeaways

  • Not all PCOS = insulin resistance — phenotype matters
  • HOMA-IR easier than OGTT — single fasting draw
  • Metformin 1500mg/day OR GLP-1 are first-line interventions

Testing approaches

Fasting insulin + glucose → HOMA-IR = (insulin × glucose) / 405. Score >2.5 indicates IR. OGTT with insulin levels more sensitive but 2-hour clinic visit. A1c shows downstream effect (prediabetes 5.7-6.4%).

Treatment hierarchy

1) Lifestyle: low-glycemic diet + resistance training + walking after meals. 2) Metformin 500mg titrate to 2000mg max. 3) GLP-1 (semaglutide/tirzepatide) — increasingly first-line if metformin fails. 4) Pioglitazone less commonly used.

SC
Reviewed by Editorial Medical ReviewBoard-certified OB/GYN · NAMS-certified · Updated 2026-05-17

Was this helpful?

More on PCOS

The 4 PCOS phenotypes: which one are you?

PCOS has 4 Rotterdam-defined phenotypes (A, B, C, D) based on combinations of androgen excess, ovulatory dysfunction, and polycystic ovaries. Phenotype affects treatment choice.

Read →

Find a provider for PCOS

Take the matcher quiz to get a ranked list of telehealth brands tailored to your symptoms.

Take the matcher Browse providers