The Gut–Immune Connection: Why Your Microbiome Matters More in Winter

Winter often brings a rise in colds, flu, a touch of COVID, but overall slower recovery and lower energy. While many people blame the weather alone, the gut actually plays a major role in how well the immune system responds at this time of year. The gut and immune system are closely linked, and the bugs living in your gut help shape how your body reacts to viruses, inflammation and stress.

For women living with PCOS, this connection is especially important. Gut health influences inflammation, metabolic balance, cravings, hormone regulation and resilience, all of which can feel more sensitive during winter.

How Gut Health Shapes Immunity

Around seventy per cent of the immune system sits in and around the gut. The gut lining acts as a physical barrier, while immune cells monitor what enters the body. A healthy microbiome helps regulate inflammation, supports nutrient production, and contributes to a calm, balanced immune response.

When the microbiome becomes disrupted, the immune system may overreact or become less efficient. This can mean slower recovery from viruses, greater sensitivity to seasonal changes and more fatigue.

Winter brings natural shifts that can challenge the gut. Less sunlight (so less vitamin D0, dietary changes, comfort eating, reduced movement, and increased stress all influence the gut microbial environment and may alter immune resilience.

Microbiome Diversity and Immune Defence

A diverse microbiome is linked with stronger immune defence, better metabolic balance, reduced inflammation and improved digestion. Lower diversity is associated with greater susceptibility to infections and inflammatory conditions.

Some beneficial bacteria can work to strengthen the gut barrier. When the barrier is strong, the immune system remains calm and balanced. When it becomes compromised, the immune system becomes more alert and inflammation can rise.

Women with PCOS often show lower microbial diversity and higher inflammation. This can contribute to fatigue, cravings, hormonal symptoms and reduced winter resilience.

Prebiotics and Probiotics Explained

Prebiotics are fibres that feed beneficial gut bacteria. They help increase diversity and support the production of short chain fatty acids that regulate inflammation. Examples include garlic, leeks, onions, asparagus, oats, flaxseed and green bananas.

Probiotics are live microorganisms found in fermented foods. They help introduce and maintain beneficial species. Examples include kefir, sauerkraut, kimchi, miso and live yoghurt.

Including even one or two sources of these foods daily can support a healthier microbiome.

Digestive Issues That Affect Immunity: Dysbiosis, SIBO and Reflux

Gut health is not simpply about what you eat. Digestive symptoms can also influence the immune system, inflammation and overall wellbeing. Winter often brings these issues to the surface because the body is under more seasonal stress.

Dysbiosis

Dysbiosis refers to an imbalance in gut bacteria in our microbiome. This may involve too few beneficial microbes, too many inflammatory species or microbial patterns that contribute to excess gas or digestive discomfort.

Signs can include bloating, irregular bowel movements – diarrhoea and/or constipation, fatigue after meals, sugar cravings and skin flare ups. Dysbiosis is associated with inflammation and can influence insulin sensitivity and hormonal balance.

SIBO (Small Intestinal Bacterial Overgrowth)

SIBO occurs when bacteria that belong in the large intestine migrate into the small intestine. This can interfere with digestion and nutrient absorption.

Common signs include bloating that worsens through the day, abdominal discomfort, diarrhoea or constipation, nausea and persistent food reactions. SIBO is often assessed through a breath test which measures hydrogen or methane gases produced by gut bacteria.

Reflux and Upper Digestive Issues

Reflux, heartburn and upper abdominal discomfort can also affect the gut–immune connection. These symptoms may relate to imbalanced gut bacteria, delayed stomach emptying, stress or certain trigger foods.

Reflux can reduce sleep quality and contribute to inflammation, both of which weaken immune resilience. Supporting digestion through balanced meals, eating slowly and avoiding late eating can help.

When Testing Can Help

Testing is not always required, but it can be helpful for people with ongoing digestive symptoms.

Comprehensive stool tests: These provide information on microbial diversity, beneficial and opportunistic bacteria, digestion and absorption markers, inflammation levels and yeast overgrowth.

Breath tests for SIBO: These measure hydrogen and methane gases produced after a specific carbohydrate substrate is ingested. This helps determine whether bacterial overgrowth may be contributing to symptoms.

These tools help build a clearer picture of what is happening in the gut and can guide more personalised nutrition and lifestyle strategies. If you are interested in any of this testing, please do get in touch.

Best Foods for a Winter Proof Gut

Focusing on gut friendly foods at this time of year supports both digestion and immunity.

• Fibre rich vegetables: Aim for a wide range including carrots, kale, leeks, beetroot, broccoli and Brussels sprouts.
• Fermented foods: Include kefir, live yoghurt, sauerkraut or kimchi a few times per week.
• Polyphenol rich foods: Berries, apples, olive oil, green tea, herbs and spices help modulate inflammation.
• Healthy fats: Omega 3 rich foods such as salmon, sardines, walnuts and flaxseed support immune balance.
• Protein: Protein helps stabilise blood sugar and supports immune cell function.

These foods help create a microbiome that is more resilient and better equipped to support your immune system through winter.

Bringing It All Together

Your gut plays a central role in how well your immune system copes during winter. A diverse and balanced microbiome supports a calmer immune response, steadier energy, healthier digestion and lower inflammation. Digestive issues such as dysbiosis, reflux or SIBO can place extra strain on the gut–immune axis which is why symptoms often feel more noticeable during colder months.

This connection matters even more for women with PCOS. Gut health influences inflammation, insulin sensitivity and hormone regulation, which means that an imbalanced microbiome can make PCOS symptoms feel stronger. Research shows that women with PCOS are more likely to experience dysbiosis and lower microbial diversity, and this can contribute to cravings, fatigue, irregular cycles and higher inflammatory markers. Supporting the gut is therefore not only helpful for immunity but also for managing the wider metabolic and hormonal picture of PCOS.

By focusing on simple, consistent changes such as increasing fibre, including fermented foods, supporting digestion and reducing ultra processed foods, you can strengthen your microbiome and support both immune and hormonal balance. Many women notice fewer flare ups, more stable energy and improved symptoms when they support their gut in this way.

If you feel run down every winter, struggle with digestion or suspect your microbiome needs more attention, this is an ideal time to start making changes. Or if you’d like to know more, why not get in touch?

Tired, Run-down and Inflamed? Is Inflammation Driving your PCOS?

What is inflammation?

Inflammation is the body’s natural defence mechanism. When you injure yourself or catch an infection, your immune system releases chemical messengers to repair tissue and fight off pathogens. This short-term, or acute inflammation, is essential for healing.

However, when the immune system stays slightly switched on over time, a state of chronic low-grade inflammation develops. It’s subtle, often without clear symptoms, but measurable in the body through elevated inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), or tumour necrosis factor-alpha (TNF-α).

Unlike acute inflammation, this persistent “background” inflammation can quietly affect many systems, including metabolism, hormones, fertility, gut health, and immune resilience. In other words, even though you may not feel overtly unwell, your body may still be under a gentle but ongoing immune strain.

The link between PCOS and chronic low-grade inflammation

Many studies show that women with Polycystic Ovary Syndrome (PCOS) tend to have higher levels of inflammatory markers compared to women without PCOS. This suggests that inflammation is part of the underlying physiology of the condition rather than just a by-product.

Researchers describe PCOS as a metabolic–endocrine–immune disorder, where factors like insulin resistance, excess androgens, and oxidative stress contribute to immune activation. The picture is complex: insulin resistance can increase inflammation, while inflammation itself can worsen insulin resistance, creating a vicious cycle.

Obesity and central fat accumulation often amplify this process because adipose tissue releases inflammatory cytokines. However, even lean women with PCOS can show signs of immune dysregulation, suggesting that the inflammation is not simply weight-related.

This persistent low-level inflammation may also influence how the ovaries function, affect egg quality, and disrupt normal ovulation. For many clients, this explains why symptoms such as fatigue, sluggish recovery from illness, acne, and irregular cycles tend to flare during times of increased stress or poor immune health.

How inflammation affects hormones 

Inflammation has wide-reaching effects on hormone balance:

1. Hormone production and clearance.
Pro-inflammatory molecules can disrupt ovarian function, reducing the ability of follicles to mature properly and affecting ovulation. Chronic inflammation also alters the way hormones are processed in the liver, which can lead to higher circulating androgens.

2. Insulin resistance and androgen excess.
Inflammation reduces insulin sensitivity, which in turn raises insulin levels. Elevated insulin drives the ovaries to produce more androgens (such as testosterone), worsening typical PCOS symptoms like acne, hair growth, and irregular periods.

3. Egg quality and implantation.
Within the ovaries, inflammatory cytokines and oxidative stress can damage developing follicles and reduce oocyte quality. This can make conception more difficult and may increase miscarriage risk.

4. Metabolic and cardiovascular risk.
Long-term inflammation contributes to higher risk of metabolic syndrome, type 2 diabetes, and cardiovascular disease, all conditions that are more prevalent in women with PCOS.

When clients describe being “constantly run down” or “taking ages to recover from colds,” it may reflect immune system overactivity and low resilience driven by this chronic inflammatory state.

Signs of inflammation in PCOS

Low-grade inflammation often goes unnoticed because it doesn’t cause the typical redness, swelling, or pain associated with acute inflammation. Still, there are patterns and symptoms that suggest it may be at play:

• Feeling constantly tired or taking longer to recover from illness
• Frequent colds or infections
• Worsening PCOS symptoms in times of stress or fatigue
• Irregular cycles, acne, or oily skin that flare around winter or illness
• Raised inflammatory markers such as CRP or white blood cell count (if tested)
• Digestive issues or gut dysbiosis, which can contribute to immune imbalance

Feeling “drained and exhausted by December” can often reflect a combination of immune strain, nutrient depletion, and chronic inflammation.

Steps to reduce inflammation

While inflammation is part of the body’s natural defence, long-term low-grade inflammation can be influenced by lifestyle and nutrition. The goal isn’t to “switch it off”, but to bring the body back into balance.

1. Improve insulin sensitivity and body composition.
Because insulin resistance drives inflammation, improving metabolic health is key. Regular movement, strength training, balanced meals, and reducing visceral fat all help reduce inflammatory signals. See more details here.

2. Eat an anti-inflammatory diet.
A Mediterranean-style pattern, one rich in vegetables, herbs, olive oil, oily fish, nuts, seeds, legumes (if tolerated), and colourful plant foods, is linked with lower inflammatory markers. Reducing refined sugars and ultra-processed foods helps stabilise blood glucose and reduce oxidative stress.

3. Support gut health.
Around 70% of the immune system sits within the gut. A disrupted microbiome or increased intestinal permeability (“leaky gut”) can promote systemic inflammation. Include diverse fibres, fermented foods, and prebiotic vegetables while avoiding excessive alcohol or ultra-processed foods that irritate the gut lining. Or get in touch if you’d like to investigate the root cause of your gut issues.

4. Optimise key nutrients.
Certain nutrients have been shown to help regulate inflammation, including omega-3 fatty acids, vitamin D, magnesium, selenium, and antioxidants such as polyphenols. While these can come from food, clients may wish to discuss testing or supplementation with their practitioner.

5. Manage stress and prioritise rest.
Chronic stress keeps cortisol high and the immune system on alert. Techniques such as yoga, walking, breathwork, journalling, or meditation can help regulate the body’s stress response and reduce inflammatory signalling.

6. Focus on winter resilience.
During the colder months, clients often experience more colds and fatigue. I encourage them to maintain vitamin D levels, eat adequate protein, include immune-supportive foods like garlic, mushrooms, and zinc-rich seeds, and make space for recovery instead of pushing through fatigue.

7. Support hormone balance through the cycle.
Because inflammation can vary with hormonal changes, I recommend balanced meals with protein, fibre and healthy fats throughout the month. Regular sleep, exercise, and stress management help buffer the hormonal impact of inflammation.

Have a go at tracking your energy, mood, cycle regularity, and immune resilience over time to identify improvements and patterns.

And if you’re interested in working with one of our practitioners on your gut health, looking to see if that or food sensitivities or intolerances may be driving your symptoms, please get in touch. We offer a range of testing options that we can discuss further with you.

Why movement matters in PCOS

Many of my clients with PCOS describe the same pattern: constant cravings, afternoon energy dips, and a sense that workouts don’t really make much of a difference. These can be common experiences when insulin resistance is part of the picture.

However, regular physical activity is one of the most effective ways to improve insulin sensitivity, support glucose control, and enhance overall metabolic health in PCOS. Exercise also benefits mood, sleep quality, and body confidence - all key areas that can be affected by PCOS.

The 2023 International Evidence-Based PCOS Guideline identifies movement as a first-line approach to managing PCOS symptoms and improving long-term health. UK guidance recommends at least 150 minutes of moderate activity per week (such as brisk walking or cycling) or 75 minutes of vigorous activity, along with strength training on two or more days each week. Breaking up long periods of sitting is equally important.

Strength training and insulin sensitivity

Resistance or strength training plays a central role in improving insulin sensitivity. It increases muscle mass, and muscle tissue is one of the main sites where glucose is stored and used for energy. The more efficiently muscles take up glucose, the less insulin the body needs to produce, reducing insulin resistance over time.

Several studies have shown that women with PCOS who include resistance training experience improvements in insulin sensitivity, body composition, and metabolic markers. This type of exercise also helps protect bone density and maintain healthy weight as we age.

If you’re new to it, begin with two sessions per week using your bodyweight, resistance bands, or light dumbbells. Focus on controlled movements that target major muscle groups - such as squats, lunges, presses, and rows. Over time, gradually increase the challenge by adding repetitions, sets, or resistance. But do check with your GP if you are new to exercise or have any other health conditions.

Cardio and blood sugar balance

Aerobic or cardiovascular exercise helps the body use glucose more efficiently during and after activity. For women with PCOS, both moderate-intensity and interval-based cardio have been shown to improve insulin resistance and cardiovascular fitness.

Moderate-intensity options include brisk walking, swimming, or cycling at a pace where you can still hold a conversation. If you enjoy shorter, more dynamic workouts, interval training, alternating periods of higher effort with active recovery can be highly effective for improving insulin sensitivity and energy levels.

Aim for activities you genuinely enjoy and can maintain consistently. The goal is regular movement, not perfection.

The role of daily activity (walking, stretching)

Exercise isn’t only about structured workouts. Small amounts of daily movement make a real difference to blood sugar control and energy levels.

Simple habits, like walking after meals, taking the stairs, standing during phone calls, or doing gentle stretches before bed, all help counter the effects of prolonged sitting.

Even 10 minutes of light activity after eating can support post-meal blood glucose regulation and help stabilise afternoon energy. Over time, these micro-movements build a foundation of consistent activity that supports metabolic and hormonal balance.

How to find the right exercise for you

The most effective movement plan is one that fits your current energy, preferences, and lifestyle. Consistency matters more than intensity.

A balanced weekly routine might include:

• Two sessions of strength or resistance training
• One to three sessions of cardio or aerobic activity
• Light daily movement to reduce sedentary time

If you’re feeling tired, recovering from illness, or just getting started, gentle movement such as stretching, walking, or yoga is still beneficial. Gradually build up frequency and intensity as your energy and confidence grow.

For best results, pair regular movement with balanced nutrition, good sleep, and effective stress management - all of which further support insulin sensitivity and hormone balance.

For further information, check out our blog How to Fuel Exercise with PCOS or why not book a call?

This article is for educational purposes only and does not replace medical advice or diagnosis.

PCOS-Friendly Lentil and Spinach Stew

Many women with PCOS find that meals high in refined carbohydrate leave them hungry or craving sugar soon after. Building meals with protein, fibre, and low-GI carbohydrates helps slow glucose release and support steadier energy. 

Pulses such as lentils are naturally low GI and high in fibre and protein, which can help moderate post-meal blood glucose. 

Lentils
Plant protein plus soluble fibre slow carbohydrate absorption and support fullness. As a low-GI pulse, lentils are a useful base for blood-sugar-friendly meals.  

Spinach
Very low in carbohydrate and a source of magnesium and folate, nutrients involved in energy metabolism and general health. 

Onion and garlic
Add natural flavour. Emerging human research suggests garlic may improve some metabolic markers (glucose/insulin indices) in certain adult groups.

Tomatoes
Provide vitamin C and carotenoids such as lycopene, contributing to an overall nutrient-dense, plant-forward pattern.

Serves: 2–3

Ingredients

• 1 tbsp olive oil
• 1 small onion, finely chopped
• 2 garlic cloves, crushed
• 1 tsp ground cumin
• ½ tsp turmeric
• ½ tsp smoked paprika (optional)
• 1 medium carrot, diced
• 1 red pepper, chopped
• 150 g dried lentils (red), rinsed
• 400 g tinned chopped tomatoes
• 500 ml good quality stock
• 1 bag baby spinach
• Juice of ½ lemon
• Sea salt and black pepper, to taste
• Fresh parsley or coriander, to garnish

Method

1. Warm the olive oil in a saucepan over medium heat. Soften the onion for 5 minutes.
2. Stir in garlic, cumin, turmeric, and paprika for 1 minute until fragrant.
3. Add carrot, pepper, lentils, tomatoes, and stock. Bring to the boil, then simmer 20–25 minutes, stirring occasionally, until the lentils are tender and the stew thickens.
4. Fold in spinach to wilt, 2–3 minutes.
5. Add lemon juice, season, and finish with herbs.

Serving suggestions and variations

• Extra protein: Top with grilled chicken, prawns, or tofu.
• Extra texture: Add toasted seeds or a spoon of Greek yoghurt.
• Make it spicier: Add chilli flakes or fresh ginger.
• Batch cook: Double the recipe and freeze portions.

Get more blood sugar-friendly recipes by joining our free private Facebook group – PCOS Unlocked – or check the Recipes section of the blog.

5 Simple Food Swaps to Beat Sugar Cravings with PCOS

Many women with PCOS describe feeling stuck in a cycle of cravings, fatigue, and energy dips. I often hear clients say things like:

• “I feel like I’m constantly craving sugar.”
• “If I eat breakfast, I’m hungry again by mid-morning.”
• “I crash in the afternoon and reach for something sweet.”

These are signs that your blood sugar might be fluctuating more than it should be. When blood sugar rises quickly after eating, the pancreas releases insulin to move glucose into your cells for energy. Over time, repeated spikes can make the body less responsive to insulin’s signal — a key feature of PCOS known as insulin resistance.

Balancing blood sugar helps reduce cravings, stabilise energy, and support hormone regulation. And the good news is, it doesn’t mean cutting out all carbohydrates! We just need to make a few simple swaps that help your body use energy more efficiently.

Swap 1: White carbs → colourful veggies and legumes

Refined carbohydrates such as white bread, pasta, or rice are digested quickly, leading to sharp rises in blood sugar and insulin. Replacing some of these with non-starchy vegetables and fibre-rich legumes can help keep blood sugar steady and provide more vitamins, minerals, and antioxidants.

Try switching to:

• Cauliflower rice instead of basmati rice, or at least mixing it half and half
• Lentils, chickpeas, or beans as a base for curries, soups, and salads – or as a base for pan-fried fish or chicken
• Vegetable noodles (like courgetti or carrot ribbons) instead of refined pasta

Vegetables and legumes add fibre, colour, and texture to meals while supporting healthy digestion and a more balanced insulin response. For ideas, see our Courgetti – Three Ways recipe.

Swap 2: Sugary snacks → protein-based snacks

That mid-afternoon biscuit or cereal bar may give a quick lift, but it often leads to a crash soon after. Protein slows digestion and releases glucose gradually, helping you stay satisfied for longer.

Try replacing sugary snacks with:

• A handful of mixed nuts and a few berries
• Apple slices with nut butter
• Greek yoghurt with flaxseed and cinnamon
• Oatcakes with hummus or boiled eggs

A little protein between meals helps stabilise mood and energy while reducing the urge to reach for something sweet.

Swap 3: Fruit juice → fruit paired with protein

Fruit juice, even when labelled “100% pure”, contains concentrated sugars without the fibre that helps slow absorption. This can cause a quick rise and fall in blood sugar.

Whole fruit is a better option, especially when paired with protein or healthy fats to keep energy steady. For example:

• Berries with a few almonds or pumpkin seeds
• A small apple with nut butter
• Sliced pear with Greek yoghurt

Pairing fruit with protein supports satiety and smoother energy through the morning or afternoon.

Swap 4: Sugary breakfasts → savoury, protein-rich breakfasts

Starting the day with a sugary cereal or pastry may feel comforting, but it often leads to mid-morning energy dips. A savoury, protein-rich breakfast balances blood sugar and supports hormone health throughout the day.

Try options like:

• Scrambled eggs or tofu with spinach and tomatoes on rye or sourdough toast
• Smoked salmon with avocado on oatcakes
• A veggie omelette cooked in olive oil
• Savoury overnight oats made with milk, chia seeds, ground flaxseed, and grated courgette

These breakfasts combine protein, healthy fats, and fibre to help you stay full, focused, and energised.

Swap 5: Processed ready meals → simple home-prepped meals

Ready meals are convenient but often contain refined oils, added sugars, and low-quality fats that can make blood sugar harder to manage.

Cooking simple meals at home doesn’t need to be complicated. Start small:

• Batch-cook soups, curries, or stir-fries at the weekend
• Use olive oil, herbs, and spices instead of sugary sauces
• Combine lean proteins like chicken, fish, tofu, or lentils with plenty of colourful vegetables

Even one or two home-cooked meals each week can help improve energy, digestion, and overall wellbeing.

Small changes, big impact

Balancing blood sugar isn’t about restriction or perfection, it’s about consistency. Small, everyday swaps can support steadier energy, reduce cravings, and make it easier to manage PCOS symptoms in the long term.

Try one or two of these swaps this week and notice how your body responds. Over time, these small steps can make a real difference to your energy, mood, and hormonal balance.

For more on managing symptoms, visit my blog on PCOS Symptoms.

If you’re ready to balance your blood sugar and feel more energised, book a free discovery call to explore how a personalised nutrition plan can support your PCOS journey.

This article is for educational purposes only and does not replace medical advice or diagnosis.

PCOS and Insulin Resistance: What You Need to Know

What is insulin resistance?

Insulin is a hormone made by your pancreas that helps move glucose (sugar) from your blood into your body’s cells, where it can be used for energy. When, over time and with increased levels, cells in the muscles, liver, and fat tissue become less responsive to insulin’s signal, your pancreas compensates by releasing more. This is called insulin resistance.

Over time, if insulin levels stay high (known as hyperinsulinaemia), the system becomes strained. This increases the risk of higher blood sugar levels and, in the long term, type 2 diabetes.

The latest international PCOS guidelines highlight that insulin resistance is a common feature of PCOS and recommend assessing blood glucose control with an oral glucose tolerance test (OGTT), rather than measuring insulin directly.

Why insulin resistance happens in women with PCOS

Insulin resistance can affect anyone, but it’s especially common in PCOS due to a mix of genetic, hormonal, and metabolic factors, not simply weight or diet.

Key factors include:

1. Cellular insulin signalling changes
Women with PCOS can have differences in how their cells respond to insulin, even at a healthy weight. The muscles and fat tissue don’t take up glucose efficiently, so the pancreas produces more insulin to compensate.

2. Androgen excess
High androgen levels, one of the defining features of PCOS, can reduce how well the body responds to insulin. Meanwhile, high insulin can also drive-up androgen levels, creating a vicious cycle that reinforces both problems.

3. Visceral fat and inflammation
Fat stored around the abdomen produces inflammatory molecules that interfere with insulin’s action. Even small reductions in waist size can make a measurable difference to insulin sensitivity.

4. Genetic predisposition
Insulin resistance and type 2 diabetes often run in families. Genetic factors linked to PCOS can affect how the body regulates insulin and glucose metabolism.

5. Cellular energy and oxidative stress
Emerging research suggests that reduced mitochondrial efficiency (how cells produce energy) and oxidative stress can also impair insulin function in women with PCOS.

These overlapping mechanisms explain why insulin resistance can occur in both lean and overweight women with PCOS, and why it requires a personalised, whole-body approach.

Why hyperinsulinaemia makes PCOS symptoms worse

Persistently high insulin levels can influence other hormone systems and worsen many PCOS symptoms.

Androgen excess
High insulin stimulates the ovaries to produce more testosterone and lowers sex hormone-binding globulin (SHBG), increasing the amount of active testosterone in circulation. This contributes to acne, oily skin, and excess hair growth.

Ovulation disruption
Elevated insulin and androgens can disrupt the hormonal feedback loop needed for ovulation, leading to irregular or absent periods and difficulty conceiving.

Weight management challenges
Insulin promotes fat storage, especially around the abdomen. This creates a cycle where higher insulin makes weight loss more difficult, and higher fat levels worsen insulin resistance.

Cravings and appetite changes
Fluctuating blood sugar and insulin can disrupt hunger hormones such as leptin and ghrelin, leading to intense sugar cravings and a feeling of never feeling full.

Mood and energy
Blood sugar swings can affect energy and concentration. Many women report fatigue, brain fog, or irritability that improve once blood sugar becomes more stable.

Signs and symptoms of insulin resistance

Insulin resistance develops gradually, so it’s easy to miss. While there is no single symptom, these patterns are common among women with PCOS:

• Strong sugar or carbohydrate cravings
• Feeling tired, shaky, or irritable between meals
• Difficulty losing weight despite a balanced diet
• Weight gain mainly around the middle
• Feeling hungry again soon after eating
• Fatigue after carbohydrate-rich meals
• Darkened, velvety skin patches on the neck or underarms (acanthosis nigricans)
• Acne, oily skin, or unwanted hair growth
• Irregular or missing periods
• Blood tests showing raised triglycerides, low HDL cholesterol, or elevated glucose or HbA1c

Recognising these early signs allows you to take proactive steps through nutrition and lifestyle before complications develop.

Practical next steps if you’re concerned

If several of these symptoms sound familiar, here are steps to support metabolic and hormonal balance – but always seek guidance from your GP or a registered nutrition professional before making major changes.

Request appropriate testing
Ask your GP whether an Oral Glucose Tolerance Test (OGTT) is suitable for you. It’s the most sensitive way to assess glucose handling in PCOS.

Review your wider metabolic picture
Blood pressure, cholesterol, liver function, and waist measurement all contribute to understanding overall metabolic health.

Focus on balanced eating
There is no single “best” diet for PCOS, despite what influencers might try and tell you! It depends on the individual. However, it is best to focus on:

• Protein at every meal to support satiety
• Fibre-rich vegetables to slow glucose release
• Whole-food carbohydrates, such as veggies and legumes, in moderate portions
• Healthy fats to support hormones

Over-restricting carbohydrates can cause fatigue and cravings, so aim for balance rather than extremes.

Move regularly
Regular movement improves insulin sensitivity. A combination of brisk walking, cycling, or swimming along with weight or strength training offers broad benefits. Consistency matters more than intensity.

Prioritise sleep and stress management
Poor sleep and chronic stress raise cortisol, which can worsen insulin resistance. Good sleep hygiene and simple stress-reduction techniques can make a noticeable difference.

Insulin resistance and diabetes risk
Research shows that women with PCOS are at a higher risk of developing impaired glucose tolerance and type 2 diabetes, even at a healthy weight. This happens because insulin resistance often develops earlier and progresses more quickly in PCOS. Studies show that women with PCOS have a four- to eight-fold increased risk of type 2 diabetes compared with women without PCOS.

Over time, if insulin levels stay high, the pancreas may struggle to keep up with demand, leading to rising blood glucose. Early identification and consistent lifestyle changes can significantly reduce this risk.

Regular blood sugar checks and ongoing metabolic monitoring are therefore key parts of long-term PCOS care. The goal isn’t restriction - it’s understanding and prevention.

For a refresher on the fundamentals, see What is PCOS?

If you’d like to understand your blood sugar and hormone balance better, book a consultation to create a tailored, evidence-based nutrition and lifestyle plan designed to support PCOS and insulin sensitivity.

This article is for educational purposes only and does not replace medical advice or diagnosis.