The Hormonal–Metabolic Puzzle of PCOS: Linking AMH Levels, Body Fat Distribution, and Insulin Resistance in Overweight and Obese Women

Background: The relationship between AMH (anti-Müllerian hormone) levels, fat distribution, and insulin resistance in women with PCOS has been widely studied, yet findings remain inconsistent. Recent guidelines emphasize the growing role of AMH in PCOS diagnosis and suggest its potential inclusion among diagnostic criteria, highlighting its relevance for guiding therapeutic management. Objectives: This retrospective study aimed to evaluate the association between AMH levels and metabolic parameters in overweight and obese reproductive-age women with PCOS. Ethical approval was obtained from the bioethics committee. Methods: Two groups of 52 women each were selected from PCOS patients treated at our clinic between 2024 and 2025: one with a waist-to-hip ratio (WHR) ≤ 0.85 and the other with a WHR > 0.85. Venous blood samples were collected to measure AMH, fasting glucose, and fasting insulin. Body height and weight were recorded to calculate body mass index (BMI), and insulin resistance was assessed using HOMA-IR. Waist and hip circumferences were measured to determine WHR. Results: The association between central adiposity and AMH in overweight and obese women with PCOS depended on insulin resistance. In insulin-resistant women, higher WHR was linked to lower AMH, whereas in women without insulin resistance, higher WHR corresponded to higher AMH levels. Conclusions: Insulin resistance appears to influence AMH in opposite directions depending on a woman’s WHR, suggesting its potential role in tailoring individualized treatment strategies.