When Is Weight Gain a Sign of PCOS?

Affecting as many as 5 million women in the US, PCOS is the most common endocrine disorder in women of child-bearing age. PCOS has become more prevalent in recent years coinciding with the growth of the obesity epidemic. Weight management is often recommended to help manage PCOS symptoms, so it’s important to understand how the two health issues are related. Read on to learn more about PCOS and the weight gain associated with it. 

The hormonal imbalance at the root of PCOS

Using the Rotterdam criteria, PCOS is defined by the presence of at least two of the following: 

• Irregular or missed menstrual periods
• Increased levels of androgens (male hormones)
• Polycystic ovaries  
  

While genetic and environmental factors are believed to play a role in the development of the disorder, the hormonal imbalance at the root of PCOS stems from elevated levels of androgens.  

In a healthy menstrual cycle, ovulation, or the release of a mature egg from the ovary, occurs each month. In contrast, for women with PCOS, high androgen levels prevent ovulation. This can result in irregular periods and the formation of follicles on the ovaries, more commonly called cysts (hence the name polycystic ovary syndrome).

High androgen levels also cause excess insulin production in women with PCOS. Increased appetite and the storage of glucose as fat (both products of excess insulin) can result in weight gain, further stimulation of androgen production in the ovaries, and worsening PCOS symptoms.

Common PCOS symptoms 

PCOS can cause a variety of hormonal symptoms (beyond the three hallmark symptoms that define the disorder, mentioned above). Here’s a breakdown of the most common ones:

Weight gain

‍To better understand the connection between weight gain and PCOS, let’s take a look at how our bodies normally process glucose (sugar): Glucose levels in the blood rise when we eat, leading to the release of insulin from the pancreas. These elevated insulin levels cause glucose to move into the cells to be used for energy, and excess glucose is stored in the liver for later use. 

In PCOS, excess androgens can lead to abdominal fat accumulation and elevated insulin levels, both of which contribute to insulin resistance, the main cause of weight gain in PCOS. Not only is weight gain a symptom of PCOS; it can also play a part in its development. Being overweight or having obesity can worsen insulin resistance and related symptoms of PCOS. Women with PCOS are also at higher risk of obesity-related health conditions such as Type 2 diabetes and heart disease.

Acne

‍Both androgen and insulin contribute to acne symptoms in women with PCOS. Receptors that bind androgen hormones are present in skin follicles. Androgen can block these follicles, causing acne lesions. Increased androgen levels in PCOS also lead to increased oil production in the skin, exacerbating existing acne. Additionally, increased testosterone levels (due to high insulin levels and insulin resistance) contribute to the development of acne.

Fertility challenges

‍ Irregular periods can put women with PCOS at greater risk of infertility. 

Changes in body hair

Androgens are responsible for hair growth in men. High androgen levels in PCOS are linked to male-pattern hair growth on the face, chest and back, as well as male-pattern hair loss or thinning on the scalp.

Symptoms of PCOS can vary significantly from one person to the next and might change over time. In fact, women might see improved symptoms as they get older and their androgen levels begin to decline naturally.

Can weight loss help alleviate PCOS symptoms?

There is no single treatment option that addresses all symptoms of PCOS, so several strategies might be needed to manage the condition effectively. Treatment goals typically include reducing androgen levels, improving insulin resistance and losing weight. 

Birth control pills might be prescribed to reduce androgen levels and regulate menstruation, while the diabetes drug Metformin can help manage blood sugar levels and regulate your response to insulin.

Studies also support the use of weight loss to help manage PCOS. A 5% reduction in total body weight, research shows, can reduce abdominal fat, improve insulin sensitivity and regulate menstruation. Weight loss can also increase the likelihood of a healthy pregnancy. 

A review paper on the effects of obesity on PCOS found that having obesity and being overweight were associated with more severe symptoms and higher rates of insulin resistance. 

While treatments such as Metformin and birth control pills can target certain symptoms of PCOS, studies suggest these treatments can produce better results when combined with weight loss. In one study, combining birth control pills and weight loss led to improvement across all symptoms, including excess body hair and infertility.

If you suspect you have PCOS, or are considering treatment for weight loss or other PCOS symptoms, it’s important to consult a healthcare provider. They can assess your symptoms, explain the available treatment options, and identify which treatment approach is best-suited to your individual needs.