HOMA What? The Marker Everyone’s Ignoring That Could Unlock Your Hormones, Energy & Fertility
Have you ever wondered why, despite your best efforts, you still feel sluggish, struggle with weight, or face challenges with your menstrual cycle or fertility?
“What am I missing?” you may ask yourself.
Or maybe you’re in another stage of your life, fresh from your doctor’s office with a prescription for BHRT, no labs in sight, and a pit in your stomach. You’re stuck between not wanting to slap a bandage on your symptoms… and being so tired of feeling bloated, irritable, anxious, or just off.
It’s like standing between a rock and a hard place: your hormones are begging for help, but your intuition is whispering, Is this the whole picture?
You're Not Alone and You're Not Broken
You’ve probably heard of estrogen, progesterone, and maybe even cortisol. But HOMA-IR? Sounds like a typo, right?
Many women I work with are surprised to learn that this weird-sounding lab marker can offer profound insights into their metabolic and hormonal health.
In fact, it’s one of the first labs I look at when helping women navigate hormone chaos, fertility struggles, or unexplained fatigue. And chances are, your regular doctor hasn’t even mentioned it.
Here’s what you’ll learn in this article:
What HOMA-IR is—and why it matters (especially for women)
The difference between functional and conventional values (with age-specific context)
Why it’s essential to address before trying to conceive
Why it’s a must-check before starting BHRT (bioidentical hormone therapy)
Let’s navigate this together.
What Is HOMA-IR, and Why Does It Matter for Women’s Health
HOMA‑IR (Homeostatic Model Assessment of Insulin Resistance) is a calculation based on two lab values: fasting glucose and fasting insulin. It estimates how well your body responds to insulin, the hormone responsible for ushering sugar out of your blood and into your cells.
When that process gets sluggish, insulin resistance creeps in. And it doesn’t just affect blood sugar: it impacts fertility, hormone function, inflammation, and aging.
🔢 How It's Calculated:
HOMA-IR = (Fasting Glucose × Fasting Insulin) ÷ 405
📊 Functional vs. Traditional Values, Based on Age
👉 Functional medicine aims to catch subtle shifts before symptoms escalate, while conventional medicine may not flag insulin issues until prediabetes or diabetes has already begun.
Why Catching HOMA-IR Early Matters
Improving insulin sensitivity can:
- Restore healthy ovulation and cycles.
- Increase energy and reduce inflammation.
- Improve moods, sleep, and brain clarity.
- Help your body respond better to hormone therapy (if you need it).
- Prevent long-term issues like PCOS, diabetes, and thyroid dysfunction.
🔍Information is power, and you’re essentially Wonder Woman if you go to your doctor’s office with this information beforehand. HOMA-IR is a marker every woman should assess before taking any other step in whatever health journey they are on.
👶 Trying to Conceive? HOMA-IR Could Make or Break Your Fertility Journey
“Can insulin resistance affect ovulation?” “How can I lower HOMA-IR before IVF?” “I’m not overweight—can I still have insulin resistance?”
These are just a few of the real-life questions women ask in Reddit threads, DMs, and consults. The answer to all: yes.
How HOMA-IR Impacts Fertility
High insulin blocks ovulation by disrupting LH and FSH
Drives elevated androgens (like in PCOS), poor egg quality
Decreases ovarian responsiveness during IVF or egg retrieval
Increases inflammation, which reduces implantation and conception chances
What to Know Before You Try to Conceive
Ideal HOMA-IR for fertility: under 1.5
Addressing insulin resistance before trying to conceive increases success rates naturally and with IVF.
Many women with normal weight still have high HOMA-IR due to stress, poor sleep, or inflammation.
What Else Should You Consider?
Run labs: HOMA-IR, hs-CRP, ferritin, thyroid panel, DHEA, and testosterone.
Support inflammation and metabolic flexibility with gentle movement, quality carbs, and stress reduction.
How to Lower HOMA-IR Naturally
Focus meals on protein + fiber + healthy fats.
Consider adding inositol, berberine, or chromium (under professional guidance).
Sleep 7–9 hrs/night, poor sleep alone can spike insulin resistance.
Lift weights or do resistance training 2–3x/week.
How Long Until You See Improvement?
Most women see shifts in 8–12 weeks with consistent support. Energy improves first. Cycles may regulate within 3–4 months. IVF success rates also rise after metabolic markers are optimized. But hey, what if you don’t even need IVF? Let’s picture the best-case scenario!
🧠 HOMA-IR & BHRT: What to Know Before Starting Hormone Therapy
“Why does BHRT sometimes make me feel worse?” “Do I need to detox before I go on hormones?” “Can estrogen improve insulin resistance?”
If you’ve been handed a hormone prescription without any prep, pause. BHRT can be incredible, but only when the terrain is ready. And HOMA-IR helps us know that.
Why HOMA-IR Should Come Before BHRT
When your body is insulin resistant, it also becomes hormone resistant:
Estrogen doesn’t land correctly
Progesterone stays low
Thyroid function stalls
Testosterone converts too easily to estrogen (aka estrogen dominance)
You may feel worse on hormones, not better.
♻️Detox Pathways: Your Hormone Drainage System
Hormones don’t just work; they need to leave the body when they’re done.
If detox pathways are blocked, BHRT can pile up and create new symptoms:
Mood swings.
Acne.
Water retention.
PMS-like flares.
Support before starting BHRT:
Poop daily (yes, it matters!). Let’s normalize talking about poop, please.
Eat cruciferous veggies (broccoli, arugula, cabbage).
Hydrate and support bile with bitters or phosphatidylcholine.
Consider DIM, magnesium glycinate, and liver support as needed (talk about it with your healthcare provider).
How We Prep Women for BHRT
Test HOMA-IR, detox, and inflammation markers
Lower insulin resistance with lifestyle + targeted supplements
Open detox pathways first (liver, gut, lymph)
Then—and only then—start low-dose, high-quality BHRT
Can BHRT Lower HOMA-IR?
Yes. Especially, transdermal estradiol has been shown to improve insulin sensitivity. But results are best (and safest) when you're already in a metabolically healthy place.
🩺 Don’t Put Hormones on a Wobbly Foundation
Whether you’re starting BHRT or TTC, if your body is stuck in insulin resistance and your detox pathways are backed up, you’re asking it to do too much with too little. Your results depend on what you do first. HOMA-IR and detox aren’t “nice-to-haves”; they’re the gatekeepers to real progress.
Want more guidance like this? Join my waitlist for first access to upcoming hormone and fertility programs and other doctor-curated tools designed to support your healing, step by step.
And hey, let’s get social. I check my DMs daily.
You’ve got this, queen!
In Health,
Dr. Krystalyn
