PCOS Belly: Hormonal Weight Gain And Tips to Reduce It

Chances are your body doesn’t look the same as it did in your teens and early twenties. While hormonal shifts are normal and will impact your body as you age, managing your weight while dealing with serious imbalances is an uphill battle.

Polycystic Ovarian Syndrome (PCOS) is a common condition that affects up to 20% of women(1). If you’re a woman with PCOS, you may have come across the term ‘PCOS Belly’ and even wondered if you are developing it.

So why does PCOS Belly affect certain people and is there a way to get rid of it or prevent it from getting worse?

Here’s a full breakdown of PCOS and the commonly associated ‘PCOS Belly’ — what it is, what causes it, and top recommendations to treat it.

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What is PCOS Belly?

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PCOS Belly is a term used to describe the disproportionate accumulation of belly fat in a woman living with PCOS. A large study revealed that women with PCOS have a much higher prevalence of central obesity than those without PCOS (2).

Even women diagnosed with PCOS who had normal to only slightly overweight BMIs were found to have a higher accumulation of fat within their abdominal regions, hence the term ‘PCOS Belly’.

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What is PCOS and Why Does it Cause Weight Gain?

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PCOS is a condition known to cause hormonal imbalance leading to excess androgens, irregular periods and/or ovarian cysts. Androgens, such as testosterone, are produced normally by the ovaries and are responsible for more masculine characteristics.

Testosterone production is necessary, even in women. In women with PCOS, however, androgens are produced at an increased level. This can lead to irregular periods, unpredictable ovulation cycles, ovarian cysts, excess or insufficient hair growth on the face and body, acne, weight gain, and insulin resistance (3).

PCOS should be suspected in any women who are of reproductive age who are experiencing irregular menses and symptoms of excess androgens such as acne, facial hair growth, or female pattern hair loss. Furthermore, if these symptoms exist in someone who struggles with being overweight or obese, the diagnosis of PCOS becomes even more likely. A doctor will diagnose PCOS based on symptoms, blood test results, and, if needed, an ultrasound to look for cysts on the ovaries. 

To make the diagnosis of PCOS, two of the three criteria are needed: 

1. Irregular periods
2. Elevated androgens manifesting as acne, facial hair, female balding, etc. - confirmed with blood tests in the doctor’s office
3. Polycystic ovaries (numerous cysts) seen on an ultrasound in the doctor’s office

Common Risks Associated with PCOS Belly

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PCOS Belly is merely a term used to describe excess fat accumulation around the abdominal region in someone living with PCOS. As with any weight gain leading to obesity, there are several risks to keep in mind. Significant weight gain (BMI >27) associated with PCOS Belly is linked to the development of conditions such as type 2 diabetes, high blood pressure, high cholesterol, non-alcoholic fatty liver disease, obstructive sleep apnea, heart disease, and stroke (4).

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Is Your Abdominal Weight Gain Connected to PCOS?

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Chances are, if you’ve been diagnosed by your doctor with PCOS and also struggle with weight loss, the two are closely intertwined. PCOS is considered an obesity-related condition—the majority of women with PCOS struggle with being either overweight or obese (5). Weight gain in women already genetically predisposed to developing PCOS contributes to the manifestation of PCOS symptoms (5).

The good news is that weight loss (even as little as 5% weight loss) can improve PCOS symptoms (5). However, due to hormonal imbalances, insulin resistance, and inflammatory response induced by PCOS, it can be difficult for people with PCOS to lose excess weight. That’s why a holistic approach to losing weight is especially important for women living with PCOS.

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How to reduce PCOS Belly

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Studies show that lifestyle changes, including diet, exercise, and behavioral interventions, can improve the health of women living with PCOS, specifically by reducing weight and BMI (6). Weight loss can lower your risk of developing severe conditions such as type 2 diabetes and heart disease and lead to improved reproductive health. Weight loss strategies combining dietary, lifestyle, and pharmaceutical changes, if necessary, are superior to any one strategy alone.

There is no way to precisely control or “spot-reduce” where we lose weight. While you cannot specifically target stubborn areas of fat in the midsection, here are the top recommendations on how to lose weight and reduce PCOS Belly in the process. 

Dietary Modifications

Nutrition is a crucial component when it comes to managing weight. Here are some helpful tips: 

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• Be calorie-conscious: When intake is less than calories burned, this is known as a calorie deficit, which can promote weight loss. When reducing caloric intake, opting for foods high in protein and fiber while low in sugar can be especially useful to keep you feeling satiated and energized.
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• ‍Manage blood sugar: Insulin resistance occurs when cells no longer respond to insulin, the hormone that regulates blood sugar, which is prevalent in people with PCOS (7). As blood sugar levels continue to rise, even when the pancreas responds with more insulin, weight gain usually follows.
  Studies have shown that for women living with PCOS, obesity, and insulin resistance, a lower-carb diet can reduce insulin levels by 30% and help lose stubborn belly fat (8, 9). 
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• ‍Eat more fiber: Studies show that getting enough fiber in your diet can help reduce belly fat and insulin resistance in women with PCOS (10). High-fiber foods include beans, lentils, whole grains, berries, and veggies such as peas, broccoli, and Brussels sprouts (11). 
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• ‍Increase protein intake: Studies also show many benefits of high-protein diets for women with PCOS. One study showed that those who consumed more protein from lean meats, beans, tofu, and protein supplements lost significantly more weight than those who consumed less protein (12).

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Lifestyle Modifications

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• Aim for high-quality sleep: Lack of sleep is linked to increased hormones ghrelin and cortisol, which may lead to overeating throughout the day. Ensuring you get plenty of sleep each night will help your weight-loss efforts. While everyone has different sleep needs, adults generally do best with 7-9 hours per night. 
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• Manage stress: Stress is certainly a risk factor for weight gain. Higher stress is correlated to higher cortisol levels, which may drive insulin resistance and weight gain. 
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• Get enough exercise: Studies have shown that women living with PCOS who incorporate moderate-intensity physical activity at least 3-5 times per week benefited from weight loss (4.5-10%), improved insulin resistance, and ovulation (13).
  
  Studies evaluating women with PCOS are limited, though the benefits of exercise in general have been more thoroughly studied. For example, a study looked at postmenopausal women who were all overweight (BMI >24, >33% body fat) and compared those who were getting moderate-intensity exercise, such as brisk walking, for an average of three hours per week (think: 30 minutes of walking per day, six days a week) to those who merely maintained a low-intensity stretching program. Over the span of 12 months, the exercisers lost significantly more weight and had a greater decrease in body fat and stubborn fat (14). 

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Medications

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Metformin: This is often prescribed for women living with PCOS. Metformin is commonly known as the preferred first-line medication used to manage type 2 diabetes. It is also commonly used off-label to manage PCOS as it’s ideal for lowering high blood sugar and insulin levels, modest weight loss, and hormonal regulation. Metformin has also been shown to promote cardiovascular health and longevity (15, 16). 

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Weight-Loss Medications: There are a number of obesity medications that can be helpful for those who have PCOS and a BMI over 30 or over 27 for those with additional weight-related health conditions (i.e., high blood pressure, diabetes). Glucagon-like peptide-1 (GLP-1) receptor agonist medications are found to be highly effective (17, 18) These include semaglutide, which is often sold under the brand name Ozempic and Wegovy, and tirzepatide, under the brand name Mounjaro and Zepbound. These weight loss medications were not developed to treat PCOS specifically. However, they can be extremely helpful to those struggling with weight loss and can be taken safely in women with PCOS struggling with PCOS Belly (19, 20). 

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We already know GLP-1 medications can be an excellent tool for weight loss. What about the other PCOS symptoms, though? Since weight loss will promote better regulation of hormones, other key aspects of health are likely to be impacted as well. In women living with PCOS, weight loss resulting from a prescribed GLP-1 may: 

• Regulate menstrual and ovulation cycles 
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• Improve blood sugar regulation
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• Reduce excess androgens (less unwanted facial hair growth, acne, etc)
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• Improve blood pressure and cholesterol

Consult with a provider at Mochi Health to see if starting a GLP-1 medication is right for you. 

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Key takeaways

Polycystic ovarian syndrome (PCOS) is a common condition affecting many women that are associated with irregular periods, unpredictable ovulation cycles, higher levels of testosterone leading to things like acne, insulin resistance, and higher accumulation of fat in the abdominal region, sometimes referred to as ‘PCOS Belly’. A healthy lifestyle, including diet, exercise, and pharmaceutical methods such as GLP-1 medications, can improve weight loss efforts in those living with PCOS and struggling with PCOS Belly.

Mochi Health is here to support you on your weight loss journey. See if you’re eligible for our holistic care plan that includes 1-on-1 provider visits, nutrition consultations, 24/7 customer support, and affordable medications delivered to your home.

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Sources

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2. Lim, S. S., Davies, M. J., Norman, R. J., & Moran, L. J. (2012). Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Human reproduction update, 18(6), 618–637. https://doi.org/10.1093/humupd/dms030
3. 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. https://doi.org/10.3390/nu15163652
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9. Kazemi, M., Hadi, A., Pierson, R. A., Lujan, M. E., Zello, G. A., & Chilibeck, P. D. (2021). Effects of Dietary Glycemic Index and Glycemic Load on Cardiometabolic and Reproductive Profiles in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Advances in nutrition (Bethesda, Md.), 12(1), 161–178. https://doi.org/10.1093/advances/nmaa092
10.  Cunha, N. B. D., Ribeiro, C. T., Silva, C. M., Rosa-E-Silva, A. C. J. S., & De-Souza, D. A. (2019). Dietary intake, body composition and metabolic parameters in women with polycystic ovary syndrome. Clinical nutrition (Edinburgh, Scotland), 38(5), 2342–2348. https://doi.org/10.1016/j.clnu.2018.10.012
11. Current dietary guidelines. Food Sources of Dietary Fiber | Dietary Guidelines for Americans. (n.d.). https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials/food-sources-select-nutrients/food-0 
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17. Davies, M., Færch, L., Jeppesen, O. K., Pakseresht, A., Pedersen, S. D., Perreault, L., Rosenstock, J., Shimomura, I., Viljoen, A., Wadden, T. A., Lingvay, I., & STEP 2 Study Group (2021). Semaglutide 2·4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet (London, England), 397(10278), 971–984. https://doi-org.offcampus.lib.washington.edu/10.1016/S0140-6736(21)00213-0
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