If you have ever been told by a doctor to just “lose weight” for your PCOS, you will know it’s not that simple and exactly how challenging PCOS weight loss can be.
In this article we’ll cover the key causes of weight gain with PCOS and what you can do about it.
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Why is it so difficult to lose weight with PCOS?
One of the common symptoms of polycystic ovary syndrome (PCOS) is a difficulty to lose weight.
Many women with PCOS struggle to lose weight, with at least 38% of women being either overweight or obese.
In many PCOS patients, losing 5-10% body weight has been shown to help with symptoms. However, women with PCOS often find it’s much harder to lose weight than those without PCOS and can end up in a vicious circle of weight-gain and worsened symptoms of PCOS.
As we’ll see in this article, the main cause of PCOS weight gain and the difficulty to lose weight is similar to other PCOS symptoms like irregular periods, acne and body hair growth: it’s the high levels of androgens present in those with PCOS. The key is to understand what is driving these high androgens such as insulin resistance, inflammation, dysregulated appetite hormones, stress and poor gut health, as these contribute to PCOS weight gain and make it difficult to lose weight.
If you have trouble losing weight with PCOS, don’t panic! It’s possible to manage and eliminate PCOS symptoms by identifying and addressing YOUR root cause.
Reminder: PCOS is a condition involving high levels of androgens (sometimes incorrectly referred to as ‘male hormones’), which suppress ovulation. In fact, our preferred term at FUTURE WOMAN for PCOS is “anovulatory androgen excess” as this classifies PCOS as a condition which must have both androgen excess AND irregular cycles present. You cannot diagnose PCOS through ultrasound alone.
How to lose weight with PCOS: 7 key drivers
Let’s look at the most common reasons why weight loss is so difficult with PCOS.
1. Insulin resistance
The majority of women with PCOS (50%-90%) are insulin resistant. This is when cells become less responsive to insulin so glucose will not be taken from the blood effectively. This causes the pancreas to release more insulin which can make it difficult to lose weight by increasing hunger, promoting fat storage around the middle and preventing the breakdown of stored fat.
2. Elevated androgen levels
Underlying factors like insulin resistance and inflammation also causes the ovaries to release excess androgens which can increase appetite and promote abdominal fat deposition. This can make it difficult to lose weight with PCOS.
Hyperandrogenism in both obese and non obese PCOS women is associated with an increased population of abdominal adipocytes (fat cells) and studies have shown that these abdominal adipocytes are also larger-sized in PCOS women compared to controls, explaining why there is a preference for fat to be stored around the belly. This makes losing weight more challenging.
3. High or low oestrogen
Oestrogen can be either high or low for women with PCOS. High oestrogen (or oestrogen unopposed by progesterone due to a lack of ovulation) can lead to difficulties with weight loss as it promotes fat storage and prevents the breakdown of fat whilst low oestrogen can cause androgen effects to be intensified, promoting weight gain.
4. Inflammation
PCOS is associated with chronic low-grade inflammation in the body. Inflammatory markers can disrupt normal hormonal regulation, including insulin sensitivity, making PCOS weight loss difficult.
5. Dysregulated appetite hormones and cravings
Hormones that regulate hunger and fullness can also be affected with PCOS. Women with PCOS have been shown to have lower satiety and higher hunger after eating than women without PCOS. This may be due to dysregulation or low levels of appetite-regulating hormone ghrelin and resistance to satiety hormone leptin.
Women with PCOS have also been shown to have increased cravings for highly palatable foods, particularly for complex carbohydrates and starches. This can make it even more difficult to lose weight.
Emotional, disordered and addictive eating can be also higher in patients with PCOS because of the self-esteem issues that come with many of the symptoms of PCOS including facial hair, acne and hair loss.
6. Stress
Stress causes cortisol to be released which encourages fat to be deposited around the waist. Cortisol also raises blood sugar levels and causes cravings for unhealthy food choices which can contribute to weight gain. Stress can also drive inflammation, which as we’ve seen can drive higher androgens, in turn preventing weight loss.
7. Gut dysbiosis
Higher levels of bacteroides and gram negative bacteria (LPS toxins) have been seen in women with PCOS and are linked to an increased risk of insulin resistance, inflammation and increased androgens all of which lead to weight gain. Therefore supporting the microbiome can help women lose weight with PCOS.
Lose weight with PCOS: a FUTURE WOMAN approach
Is it really PCOS that is driving your weight gain?
There are many hormonal drivers of weight gain in women, so firstly it’s important to determine if PCOS is the real driver for you. At FUTURE WOMAN, we see many clients have been diagnosed with PCOS purely based on ultrasound, without a test to confirm elevated testosterone or other androgens. This leads to a lot of misdiagnosis of PCOS.
Testing with our easy at home urine-based Advanced Hormone Test will help to determine if your androgens or androgen metabolites are raised, and if not, whether something else is driving your weight gain like stress, poor oestrogen metabolism or hypothyroidism.
What type of PCOS do I have?
Secondly, it is important in PCOS to determine which type of PCOS you have so that your practitioner can address the underlying root causes of your PCOS weight gain.
If you’re experiencing difficulty with weight loss, it’s most likely that insulin resistance is a driver for you, but it’s also possible that you have inflammatory PCOS (driven by inflammation) or adrenal PCOS (driven by stress).
We treat each PCOS type differently.
The Advanced Hormone Test assesses the full range of adrenal hormones, as well as many markers for inflammation to help us determine your PCOS type.
What factors are contributing to my PCOS weight gain?
As we’ve seen above, there are many factors that could be driving your PCOS weight gain and other symptoms.
In the Advanced Hormone Test, we assess both free and metabolised cortisol and cortisone for a comprehensive assessment of your stress response and HPA (hypothalamus pituitary adrenal) axis functioning. This is especially important in PCOS as increased cortisol can increase overall inflammation in the body, which in turn increases androgen production resulting in weight gain.
Other possible root causes of weight gain that would show up in our testing include poor oestrogen metabolism, high levels of inflammation, guy dybsiosis and low metabolised cortisol which might indicate an underactive thyroid.
All our tests include a personalised plan tailored to you and your results.
Check your PCOS symptoms now
Can supplements help me lose weight with PCOS?
Once we establish the drivers of your PCOS weight gain and other symptoms through testing, one of our expert nutritionists will create a personalised health plan for you. This will include evidence based supplement, diet and lifestyle recommendations to address your unique drivers and symptoms.
There are many possible supplements that could be helpful in managing your PCOS, but they need to be tailored to you as an individual. For example the supplement myo-inositol has been shown to be hugely beneficial for insulin resistant PCOS but can worsen hormonal symptoms for people who do not have PCOS. That is why it is so important to test first and work with a practitioner to determine which supplements and dietary changes are right for you.
3 tips to help with PCOS weight loss
To bring about lasting change with PCOS symptoms and lose weight, here are our top 3 recommendations.
- Confirm if you really have PCOS by testing. We see many women who have been misdiagnosed with PCOS based on ultrasound alone. You need irregular or non ovulatory cycles AND raised androgens to confirm if you have PCOS.
- Test ALL androgens and androgen metabolites. It’s not just about testosterone! PCOS can be present if ANY of your androgens or androgen metabolites are raised. Metabolites can only be tested in urine, not blood serum.
- Check other hormonal drivers of your weight gain. Every woman with PCOS is different. As we’ve covered in this article, there are many possible hormonal drivers of PCOS weight gain. Testing with the Advanced Hormone Test can help you understand your unique hormone picture and we can then address those drivers in your free personalised plan.
References
Babu, A., Devi Rajeswari, V., Ganesh, V., Das, S., Dhanasekaran, S., Usha Rani, G., & Ramanathan, G. (2024). Gut Microbiome and Polycystic Ovary Syndrome: Interplay of Associated Microbial-Metabolite Pathways and Therapeutic Strategies. Reproductive sciences (Thousand Oaks, Calif.), 10.1007/s43032-023-01450-2. Advance online publication. https://doi.org/10.1007/s43032-023-01450-2
Barber, T. M., Hanson, P., Weickert, M. O., & Franks, S. (2019). Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies. Clinical medicine insights. Reproductive health, 13, 1179558119874042. https://doi.org/10.1177/1179558119874042
Benjamin, J. J., Kuppusamy, M., Koshy, T., Kalburgi Narayana, M., & Ramaswamy, P. (2021). Cortisol and polycystic ovarian syndrome – a systematic search and meta-analysis of case-control studies. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 37(11), 961–967. https://doi.org/10.1080/09513590.2021.1908254
Chao, A. M., Jastreboff, A. M., White, M. A., Grilo, C. M., & Sinha, R. (2017). Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight. Obesity (Silver Spring, Md.), 25(4), 713–720. https://doi.org/10.1002/oby.21790
Gao, T., Wu, L., Chang, F., & Cao, G. (2016). Low circulating ghrelin levels in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine journal, 63(1), 93–100. https://doi.org/10.1507/endocrj.EJ15-0318
