PCOS and Weight Loss: The Ultimate Guide

Understanding PCOS and Weight Gain: The Complex Relationship

What is Polycystic Ovary Syndrome (PCOS)?

PCOS is an endocrine disorder that affects your hormones. The exact cause of PCOS remains unknown.   PCOS is a syndrome which means there can be different causes, and different clinical presentations. The key features are menstrual dysfunction (irregular periods) and signs of high androgen levels. 

Many refer to androgen as the “male hormone” because it controls male traits like balding or facial hair. But both females and males make it, just in different amounts. High levels of androgen affect how your ovaries work, leading to symptoms of PCOS such as:

• Irregular periods
• Acne
• Thinning or loss of hair
• Weight gain
• Infertility
• Cysts (tiny fluid-filled sacs) on the ovaries
• Darkening of skin in certain areas
• Skin tags

An estimated 6 to 10% of reproductive-age women have PCOS. Despite PCOS prevalence, there is no single test to diagnose it, because it can present in different ways. Your healthcare provider will likely ask about your symptoms and medical history and perform a physical exam. They may also order a pelvic ultrasound to check for ovarian cysts and blood work to rule out other endocrine-related disorders, such as thyroid disease. Blood work can also indicate how high your androgen level is. A high androgen level is one of the most common signs of PCOS but is not required to make a diagnosis.  

Your healthcare provider can also make a diagnosis of PCOS if you have at least two of these symptoms:

• Oligoovulatory or anovulatory cycles
• Symptoms of too much androgen, such as extra hair growth on the face, chin, and body, acne, thinning hair, or male pattern baldness
• High blood level of androgen
• Multiple cysts on your ovaries 

Why is PCOS Linked to Weight Gain?

PCOS is an obesity-related condition, meaning weight gain and being overweight are risk factors for developing PCOS.

There are two common hormonal imbalances seen in those with PCOS that may contribute to weight gain. We have already discussed one, high levels of androgens. The second is insulin. 

For background, your pancreas secretes insulin, a hormone that controls how your cells change the food you eat into energy for your body, and controls your blood sugar levels. Those with PCOS commonly have insulin resistance, meaning cells are not responding to insulin as they should. As your pancreas makes more insulin to overcome insulin resistance, blood insulin levels will increase. This excess insulin triggers your body to produce more androgen, affecting your reproductive system and metabolism.

Obesity and fat around your belly area (visceral fat) puts you at a higher risk of developing insulin resistance. While being overweight is not a direct cause of PCOS, it can exacerbate elements of the phenotype like insulin resistance. However, you can have PCOS and still have a healthy weight.

The Impact of PCOS on Metabolism

As mentioned, insulin resistance causes an excess of of insulin, which in turn can lead to excessive androgen production. When your androgen level is higher than average, it can affect your metabolism. 

Some of the metabolic effects associated with a high androgen level include the following

• Decrease in the effectiveness of leptin, a hormone that helps control your weight
• Increase in visceral fat and size of fat cells
• Reduction in “fat burning” or lipolysis 
• Lower energy expenditure

In addition, people with PCOS may have dysregulation of ghrelin, a hormone that helps regulate appetite and weight. Ghrelin increases right before a meal, signaling you are hungry, then decreases after eating, signaling your brain that you are full. Ghrelin levels may not drop low enough in those  with PCOS; hence, they may experience less satiety.. This could lead to overeating and eventual weight gain.

The Struggles: Why is Weight Loss So Hard with PCOS?

Weight gain worsens insulin resistance and PCOS symptoms. But at the same time, those with PCOS may find it harder to lose weight for the following reasons:

1. Hormonal Imbalances

Androgen and insulin are the two hormonal imbalances seen in those with PCOS. 

As discussed, insulin resistance causes high insulin levels in your blood. This can trigger your body to produce more androgens, altering your metabolism and reproductive system. These changes to your metabolism may result in additional weight gain, which worsens insulin resistance prompting your pancreas to make more insulin. More insulin in your blood means your blood androgen levels increase. 

This continuous cycle makes losing weight challenging for those with PCOS.

2. Insulin Resistance

Insulin resistance is commonly found in those with obesity. Since many people with PCOS have overweight or obesity, it may not surprise you that more than half of those with PCOS have insulin resistance.

Insulin resistance can, over time, increase your risk of developing type 2 diabetes. Over half of those with PCOS will develop type 2 diabetes before age 40. 

Type 2 diabetes isn't the only medical condition linked with PCOS. Other medical conditions you are at a higher risk of developing if you have PCOS include:

• Sleep apnea
• Stroke
• High blood pressure 
• Heart disease
• Abnormal cholesterol levels
• Gestational diabetes

On top of PCOS, having additional medical conditions could impact your ability to lose weight. 

3. Emotional Stress and PCOS

The link between obesity, PCOS, and emotional stress is complex and varies between individuals. 

Research shows poor body image and self-worth are predictors of anxiety and depression, regardless of PCOS diagnosis. Those with PCOS are more likely to have higher scores for anxiety, depression, and negative body image compared to individuals without PCOS. 

Emotional stress can prevent an individual from attempting or implementing lifestyle modifications such as physical activity or diet changes. For example, depression may contribute to weight gain due to emotional eating or lack of energy to complete physical activities. Additional weight gain contributes to insulin resistance and PCOS symptoms. This, in turn, may lead to worsening depression, thereby leading to more weight gain. 

FAQs on PCOS and Weight Loss

Can I still lose weight if I have PCOS?

Yes, you can. 

Here are four tips for losing weight with PCOS:

• Adopt a balanced diet
• Prioritize regular exercise
• Manage underlying insulin resistance, possibly with medications such as metformin 
• Address your mental health

In addition, there are prescription weight loss medications that can help you lose weight. 

Before implementing these tips, check with your healthcare provider, who can help you come up with a realistic plan to help you lose weight in a safe and healthy manner. 

What is the best diet for PCOS and weight loss?

Research shows that changing your diet can have positive effects, such as weight loss, decreased insulin and androgen levels, and improved PCOS symptoms.

Unfortunately, no single diet has been proven to be the best for those with PCOS. However, a balanced diet consisting of the following appears to provide benefits.

• Low glycemic index fruits and veggies such as mushrooms, peppers, and berries
• Low-fat dairy products
• Fish
• Lean red meat 
• Poultry
• Fatty acids like olive oil, vegetable oil, and almonds
• Beans 
• Whole grains 
• Limited alcohol intake

Working with your healthcare provider or a registered dietitian is best to find diet changes that work for you. Jumping right into a fad diet may result in initial weight loss, but you may not be able to sustain it long-term. The key to any successful diet is consistency and dedication to it. 

Are there specific weight loss supplements that can help with PCOS?

Many over-the-counter supplements claim to help with weight loss, but not all have quality evidence supporting that claim. Furthermore, supplements are not regulated by the FDA.

Inositol is a supplement that may help lower body weight. A 2021 study showed that those with PCOS taking inositol improved their weight and reduced androgen-related traits such as acne or balding. Inositol may improve insulin resistance and carbohydrate metabolism. But, this study only included a small number of participants. 

Omega-3 fatty acids may also aid in weight loss, but studies are also limited. A 2017 study showed those with PCOS who took omega-3 fatty acid supplements saw an improvement in waist circumference and other body measurements. However, there was no significant change in their scores for weight, menstrual bleeding, or excessive hair growth compared to those who did not take omega-3 fatty acid supplements. 

To achieve the best weight loss results, weight loss supplements should be used in combination with lifestyle changes, and under the supervision of your healthcare provider. 

Conclusion: Embracing Your Journey towards a Healthier You

For those with PCOS, your weight loss goals are still achievable. Addressing underlying conditions through medication therapy or lifestyle modifications may help improve your PCOS symptoms and make losing weight more manageable. 

Work with your healthcare team to develop a realistic weight loss plan that incorporates changes in your diet and exercise routine and addresses your mental health. 

Remember: You won’t reach your weight loss goals within a couple of weeks or months. It will take hard work and time, so stay encouraged even when you don’t see the results quickly, or when you have a minor setback. Stick to your outlined weight loss plan - you got this!