Discover what PCOS belly really is, it’s key drivers and what you can do about it.
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What is PCOS belly?
A common symptom of polycystic ovary syndrome (PCOS) is abdominal weight gain, often referred to as PCOS belly.
PCOS belly is the buildup of visceral fat around the stomach, while the rest of the body may not gain fat. It can be really frustrating to experience PCOS belly, and can lead to feelings of low self esteem and issues with body image. Too much visceral fat around the waist and internal organs is also dangerous for our long term health, and can put us at greater risk for things like diabetes and heart disease.
As we’ll see in this article, the causes of PCOS belly are typically the same as for other PCOS symptoms like irregular periods, acne and body hair growth: high levels of androgens present in those with PCOS, as well as common PCOS drivers like insulin resistance, can cause fat to accumulate around the belly. Other factors such as inflammation, stress and poor gut health can also contribute to PCOS belly.
If you have PCOS belly, don’t panic! It’s possible to manage and eliminate PCOS symptoms by identifying and addressing the 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.
Signs of PCOS belly
A PCOS belly shape can be large and bloated but can also be small and round. It involves deposition of visceral fat in the lower stomach and it usually feels hard to touch.
A waist measurement of 35 inches (89cm) or more or a waist-to-hip ratio of more than 0.87 may be an indication of PCOS belly.
Importantly, you do not need to be overweight to have PCOS belly, it can occur in anyone with PCOS.
PCOS belly vs. bloating
Bloating is a common symptom in women with PCOS, but this is different to PCOS belly.
PCOS belly is the actual deposition of this visceral fat around the abdomen, whereas bloating and gas can be transient, often fluctuating with your hormones as they rise and fall across your menstrual cycle.
Bloating in PCOS can often be linked to pain or discomfort, changes in bowel motions and can be impacted by the foods you eat day to day.
PCOS belly vs. water retention
Water retention can also cause a feeling of weight gain around the belly in PCOS. However, this is also different to PCOS belly.
Water retention is a form of bloating, and can therefore fluctuate and change day to day. Typically, water retention is caused by low progesterone levels (due to lack of ovulation in PCOS). Water retention can be uncomfortable and also can have symptoms like swollen ankles and can mimic rapid weight gain over a few days or weeks, whereas real weight gain like in PCOS belly takes longer to develop.
The 5 main causes of PCOS belly
Several factors can contribute to the development of PCOS belly. Let’s run through the main ones.
1. Insulin resistance
The majority of women with PCOS (50%-90%) are insulin resistant. 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 promote fat storage in the abdominal area.
2. High androgen levels
High insulin stimulates the ovaries to release more androgens. Elevated androgen levels in women can:
- Contribute to fat accumulation in the abdominal region. Hyperandrogenism in both obese and non obese women with PCOS is associated with an increased population of abdominal adipocytes (fat cells). 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.
- Increase our appetite hormone ghrelin (which makes us hungry), decrease our response to leptin (which lets us know we have eaten enough) and reduces our impulse control leading to overeating. Androgens also drive visceral fat mass accumulation in the abdominal area for women.
3. Inflammation
PCOS is associated with chronic low-grade inflammation in the body. Inflammatory markers can disrupt normal hormonal regulation and contribute to weight gain. Chronic inflammation causes the ovaries to release more testosterone which in turn can result in androgen excess.
4. Stress
Stress causes cortisol to be released which encourages fat to be deposited around the waist. The body stores fat in an area that is easier to access in an emergency, thereby increasing the chances of having PCOS belly. Stress can also drive inflammation, which as we’ve seen can drive higher androgens.
5. 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, especially around the abdomen.
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Treatment and diagnosis of PCOS belly
There are three key questions to answer when it comes to treating PCOS belly.
Do I definitely have PCOS?
PCOS is not the only cause of abdominal weight gain in women. So firstly, it’s important with PCOS belly to determine that you definitely have PCOS. At FUTURE WOMAN, we see that many women have received a PCOS diagnosis based on ultrasound alone, 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 PCOS belly. We assess all androgens in the Advanced Hormone Test, including the androgen metabolite 5a DHT, which can be three times more potent than testosterone, and is only detectable in urine testing.
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 belly in your personalised plan.
For example, insulin resistance is the most common PCOS type, and we would treat this differently to Inflammatory PCOS (driven by inflammation) or adrenal PCOS (driven by stress). 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 other factors are contributing to my PCOS belly?
As we’ve seen above, there are many factors that could be driving your PCOS belly 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 the worsening of symptoms.
Other possible root causes of PCOS belly that would show up in our testing include gut dysbiosis. An imbalance in certain gut bacteria can lead to both weight gain around the abdomen and bloating.
Supplements for PCOS belly
Once we establish the drivers of your PCOS belly and other symptoms through testing, one of our expert nutritionists will create a personalised health plan for you as part of the service. 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 need it. 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 reduce PCOS belly for good
To bring about lasting change with PCOS belly 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 PCOS belly. Every woman with PCOS is different. As we’ve covered in this article, there are many possible hormonal drivers of PCOS belly. 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
Bai, X., Ma, J., Wu, X., Qiu, L., Huang, R., Zhang, H., Huang, H., & Chen, X. (2023). Impact of Visceral Obesity on Structural and Functional Alterations of Gut Microbiota in Polycystic Ovary Syndrome (PCOS): A Pilot Study Using Metagenomic Analysis. Diabetes, metabolic syndrome and obesity : targets and therapy, 16, 1–14.
Dumesic, D. A., Akopians, A. L., Madrigal, V. K., Ramirez, E., Margolis, D. J., Sarma, M. K., Thomas, A. M., Grogan, T. R., Haykal, R., Schooler, T. A., Okeya, B. L., Abbott, D. H., & Chazenbalk, G. D. (2016). Hyperandrogenism Accompanies Increased Intra-Abdominal Fat Storage in Normal Weight Polycystic Ovary Syndrome Women. The Journal of clinical endocrinology and metabolism, 101(11), 4178–4188.
Jena, D., Choudhury, A. K., Mangaraj, S., Singh, M., Mohanty, B. K., & Baliarsinha, A. K. (2018). Study of Visceral and Subcutaneous Abdominal Fat Thickness and Its Correlation with Cardiometabolic Risk Factors and Hormonal Parameters in Polycystic Ovary Syndrome. Indian journal of endocrinology and metabolism, 22(3), 321–327.
Jurczewska, J., Ostrowska, J., Chełchowska, M., Panczyk, M., Rudnicka, E., Kucharski, M., Smolarczyk, R., & Szostak-Węgierek, D. (2023). Abdominal Obesity in Women with Polycystic Ovary Syndrome and Its Relationship with Diet, Physical Activity and Insulin Resistance: A Pilot Study. Nutrients, 15(16), 3652.
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Sharma, P., Sarkar, A., Kaur, H., Gupta, U., & Kumar, B. (2022). Visceral Adiposity Index as an Indicator for Menstrual Disturbance, Hormonal and Metabolic Dysfunction in Polycystic Ovarian Syndrome. Cureus, 14(9), e29796.
