Does the pill help with insulin resistance?

October 10, 2025 •

4 min read

An estimated 40% of young U.S. adults between 18 and 44 are insulin-resistant [1.6.1]. The question of whether the pill helps with insulin resistance is complex, as effects vary based on the pill's formulation and a woman's underlying health conditions like PCOS [1.4.6].

Quick Summary

The relationship between oral contraceptives (the pill) and insulin resistance is not straightforward. While some pills can worsen insulin sensitivity, others, particularly those with anti-androgenic properties, may be part of a management plan for conditions like PCOS.

Key Points

General Impact: Oral contraceptives, particularly the estrogen component and androgenic progestins, can decrease insulin sensitivity by 30-40% in healthy women [1.2.5, 1.3.4].
Progestin Type Matters: Pills with androgenic progestins (e.g., levonorgestrel) tend to worsen insulin resistance, while those with anti-androgenic progestins (e.g., drospirenone) may have a neutral or beneficial effect [1.2.3, 1.8.2].
PCOS Context: For women with PCOS, the pill is a primary treatment to manage high androgen levels. The benefits of androgen suppression can be a crucial part of managing the condition, despite potential metabolic effects [1.4.7].
Formulation is Key: Pills with low androgenic or anti-androgenic properties, such as those containing desogestrel, norgestimate, or drospirenone, are often preferred for women with metabolic concerns [1.4.2, 1.3.2].
Lifestyle is Paramount: Diet, exercise, and weight management are the most effective strategies for improving insulin sensitivity, regardless of contraceptive use [1.7.1, 1.7.2].
Not a Direct Treatment: The pill is not a treatment for insulin resistance itself. Its role is primarily for contraception or managing conditions like PCOS, with variable secondary effects on metabolism [1.3.3].
Consult a Doctor: The choice of contraceptive requires individualized risk assessment with a healthcare provider, especially for those with pre-existing insulin resistance, diabetes, or PCOS [1.4.5].

Understanding Insulin Resistance and Oral Contraceptives

Insulin resistance is a condition where cells in your muscles, fat, and liver don't respond well to insulin and can't easily take up glucose from your blood [1.7.1]. This requires the pancreas to produce more insulin to maintain normal blood glucose levels [1.6.2]. Over time, this can lead to prediabetes and type 2 diabetes [1.7.2]. Factors like genetics, age, and excess body weight contribute to its development [1.7.2]. According to a 2021 analysis of NHANES data, a staggering 40% of American adults aged 18 to 44 are insulin-resistant [1.6.1].

"The pill," commonly referring to combined oral contraceptives (COCs), contains synthetic versions of the hormones estrogen (usually ethinyl estradiol) and progestin [1.2.2]. These hormones work primarily to prevent pregnancy. However, they also have systemic effects on the body's metabolism, including how it processes carbohydrates and responds to insulin [1.2.4].

The Direct Impact of the Pill on Glucose Metabolism

The hormones in birth control pills can influence blood sugar levels. Both estrogen and progestin can potentially increase blood glucose and contribute to insulin resistance [1.2.1]. Studies have shown that the estrogen component can induce insulin resistance, while the type of progestin modifies this response [1.2.5]. Combined pills have been found to reduce insulin sensitivity by 30-40% in some studies [1.2.5].

This happens because the hormones can:

Decrease insulin sensitivity in healthy women [1.3.4].
Raise plasma insulin levels to compensate for the reduced sensitivity [1.3.4].
Increase triglycerides and other lipids in the blood [1.2.4].

Weight gain, a potential side effect of some hormonal birth control, is also a risk factor for developing insulin resistance [1.2.1].

The Role of Progestin Type

Not all birth control pills are created equal. The type and androgenicity (androgen-like effects) of the progestin component play a crucial role in the pill's metabolic impact.

Androgenic Progestins: Pills with more androgenic progestins, such as levonorgestrel, have been shown to significantly increase post-meal glucose and insulin levels, suggesting they may impair glucose tolerance and increase insulin resistance [1.2.3]. Studies show levonorgestrel combinations can reduce insulin sensitivity by 30-40% [1.2.5].
Anti-Androgenic and Low-Androgenic Progestins: Newer generations of progestins, like drospirenone and desogestrel, have anti-androgenic or low androgenic properties [1.4.2]. Studies suggest pills containing drospirenone may improve insulin sensitivity, while those with anti-androgenic progestins did not show the same negative impact on post-meal glucose and insulin as their androgenic counterparts [1.8.2, 1.2.3]. Formulations with norgestimate combined with synthetic estrogen are considered a better option for women with diabetes by the American Diabetes Association [1.3.2].

Comparison of Progestins and Metabolic Effects


Progestin Type	Common Examples	Androgenicity	Impact on Insulin Resistance	Reference(s)
Highly Androgenic	Levonorgestrel	High	May significantly increase insulin resistance and impair glucose tolerance.	[1.2.3, 1.2.5]
Low Androgenic	Desogestrel, Norgestimate	Low	Less impact on insulin resistance compared to more androgenic types.	[1.2.5, 1.4.2]
Anti-Androgenic	Drospirenone, Cyproterone Acetate	Anti-Androgenic	May have a neutral or even positive effect on insulin sensitivity. Drospirenone improved insulin sensitivity in one study.	[1.8.2, 1.4.2]

The Special Case: PCOS and Insulin Resistance

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women, and up to 70% of individuals with PCOS have insulin resistance [1.7.3]. This condition is characterized by hyperandrogenism (high levels of androgens), which contributes to many of its symptoms [1.4.7].

COCs are a first-line treatment for managing the symptoms of PCOS, such as irregular periods and acne, because they suppress androgen production [1.4.6, 1.4.7]. Herein lies the paradox: while COCs can worsen insulin resistance in the general population, they are used to treat a condition intrinsically linked to it. The benefit of reducing high androgen levels in PCOS can sometimes outweigh the direct negative metabolic effects of the pill [1.4.6].

For women with PCOS, pills containing anti-androgenic progestins like drospirenone are often preferred [1.4.2]. Some research indicates that a drospirenone-containing COC could better correct carbohydrate metabolism in women with PCOS compared to one with cyproterone acetate [1.8.5]. However, there is still concern that OCPs may aggravate underlying metabolic dysfunction, and this remains an area of active research [1.4.1, 1.3.3].

Lifestyle and Other Management Strategies

Regardless of pill usage, lifestyle modifications are the primary treatment for insulin resistance [1.7.2].

Diet: Focusing on a low-glycemic, anti-inflammatory diet rich in whole foods, fiber, and lean protein can help manage insulin levels [1.7.3, 1.7.2].
Exercise: Regular physical activity, including both cardio and resistance training, dramatically improves insulin sensitivity by helping muscles use glucose more effectively [1.7.1, 1.7.4].
Weight Management: For those who are overweight, losing even 5-7% of body weight can significantly reduce insulin resistance [1.7.5].
Medication: In some cases, doctors may prescribe insulin-sensitizing medications like metformin, particularly for women with PCOS or prediabetes [1.7.3, 1.7.5].

Authoritative Link: The American Diabetes Association provides comprehensive information on insulin resistance.

Conclusion

The question of whether the pill helps with insulin resistance has a nuanced answer. For many women without underlying metabolic conditions, combined oral contraceptives, especially those with older, more androgenic progestins, can decrease insulin sensitivity and worsen insulin resistance [1.2.4, 1.2.5]. However, for women with PCOS, the pill is a key treatment that manages hyperandrogenism, a driver of their metabolic issues. In this context, newer pills with anti-androgenic progestins (like drospirenone) may offer benefits for symptom management with a more neutral or even positive metabolic profile [1.8.2, 1.4.2]. The decision to use the pill should involve a detailed discussion with a healthcare provider, weighing the contraceptive and therapeutic benefits against the potential metabolic risks based on individual health status, risk factors, and the specific pill formulation.

Frequently Asked Questions

Yes, some birth control pills can decrease insulin sensitivity and contribute to insulin resistance. Studies show combined pills can reduce insulin sensitivity by 30-40%, largely due to the estrogen component and the type of progestin used [1.2.5].

There is no single 'best' option, but pills with low-androgenic or anti-androgenic progestins like drospirenone, desogestrel, or norgestimate are generally considered to have a more favorable metabolic profile [1.4.2, 1.3.2]. The final choice should be made with a doctor.

It's complicated. While the pill can decrease insulin sensitivity, it's also a first-line treatment for PCOS because it lowers androgen levels, which are a key part of the syndrome [1.4.7]. For some, the benefits of androgen control outweigh the metabolic risks, especially with newer pill formulations [1.4.6].

Stopping a pill that negatively impacts your glucose metabolism may help improve insulin sensitivity. However, if the insulin resistance is due to other factors like genetics, diet, or weight, stopping the pill alone will not reverse it. Lifestyle changes are the most effective treatment [1.7.2].

Androgenic progestins (like levonorgestrel) have effects similar to male hormones (androgens) and are more likely to worsen insulin resistance [1.2.3]. Anti-androgenic progestins (like drospirenone) work against these effects and are often preferred for conditions like PCOS and may have a better metabolic profile [1.4.2, 1.8.2].

Combining metformin, an insulin-sensitizing drug, with oral contraceptives is a common treatment strategy for women with PCOS, especially those with significant insulin resistance or a BMI over 25 [1.4.7]. This combination can improve both metabolic and hormonal outcomes. You should discuss this with your healthcare provider.

Yes. The primary ways to manage insulin resistance are through lifestyle modifications, including a balanced diet, regular exercise, weight management, and stress reduction [1.7.2, 1.7.4]. Medications like metformin can also be prescribed [1.7.5].