PCOS Belly: Hormonal Influence on Weight Gain

Polycystic ovary syndrome (PCOS) affects between 5 and 10% of women of reproductive age. It's an endocrine disorder which means it's related to a hormone imbalance. While some of these hormones can influence weight and increase weight gain around the abdomen, “PCOS belly” is not a clinical term.

There are several versions (called phenotypes) of PCOS. The most common type presents with excess body weight and hormone disruptions that make it harder to lose body fat, although it's important to note that PCOS can occur with any body size. Some research does suggest that those with PCOS are more likely to have abdominal fat deposits despite body weight, but it may vary based on body size, genetics, and more.

Despite the messaging you may see on social media, PCOS is not simply solved with weight loss and cutting calories. Women with PCOS also have an increased risk of eating disorders and body shame, making it even more important to understand the physiology behind what's happening in the body.

Here's what to know about PCOS, weight gain, and hormones, and what you can do to feel good in your body while living with PCOS.

<p class="pro-tip"><strong>Learn more: </strong> <a href="/blog/weight-loss-pcos">How to Lose Weight When You Have PCOS</a>.</p>

What's the Connection Between PCOS and Weight?

As mentioned, PCOS is related to hormonal imbalances, primarily androgen and insulin levels. The influence of these hormones may contribute to and result from higher body fat levels (especially around the belly).

Androgens are considered male hormones, but women need them too. Elevated androgens, especially testosterone, can cause PCOS symptoms like irregular periods, acne, hair growth (hirsutism), and central obesity.¹

Insulin is the hormone that helps regulate blood sugar. PCOS is closely related to insulin resistance, which means the body can't use insulin efficiently to regulate blood sugar. Insulin resistance may make it more challenging to lose weight and cause excess fat storage.¹

Insulin also triggers the ovaries to produce testosterone, and more testosterone stimulates central fat accumulation. Abdominal weight also increases insulin resistance, so the cycle perpetuates itself. 

Inflammation also plays a role in abdominal weight with PCOS. Studies suggest that abdominal fat tissue in people with PCOS may secret more inflammatory compounds that add to the health concerns. 

In other words, having PCOS can lead to metabolic changes that increase the risk of central body fat, but central body fat also adversely affects the metabolic components of PCOS.

What is PCOS Belly?

The term "PCOS belly" refers to excess weight gain around the midsection, sometimes seen in people with PCOS. Some research suggests people with PCOS may be more likely to hold weight around their middle compared to those without PCOS, but the results are mixed.

One study found that women with PCOS considered "normal" or "overweight" had more abdominal body fat than people who weighed the same but didn't have PCOS. This connection did not hold for women considered "obese,” meaning all women in the "obese" weight category had the same amount of abdominal fat regardless of whether they had PCOS. ⁷

However, other studies have found little to no connection between PCOS and increased abdominal weight.  A review found that women with PCOS often had more body fat, even when considered "normal" weight, but fat distribution did not differ. Researchers did note that many studies used different techniques of measuring body fat which could have influenced the mixed messages.⁷

What Does PCOS Belly Look Like?

Once again, it's not quite right to call your belly a PCOS belly. A stomach is just a stomach; not all people with PCOS look the same. Some women with PCOS may carry extra belly fat, while others don't. Abdominal weight gain can also happen with or without PCOS.

Understanding how abdominal weight can impact your health is essential for everyone, with or without PCOS. There are two types of abdominal fat to pay attention to: 

• Visceral fat: Visceral fat is found in the peritoneal cavity close to your organs. It's considered more dangerous because it's metabolically active, producing hormones and other inflammatory substances that can disrupt normal metabolic processes. PCOS increases the risk of visceral fat accumulation.⁹

• Subcutaneous fat: Subcutaneous fat is located directly beneath the skin and is usually visible and easy to grab (unlike visceral fat, which is harder). This type of fat is considered less dangerous, but some studies still suggest it is also metabolically active and may play a role in insulin resistance.

People with PCOS may also experience bloating, contributing to feelings of a so-called PCOS belly. Digestive conditions like irritable bowel syndrome are common with PCOS, so that bloating can become a frequent issue in combination with hormone imbalances. 

6 Symptoms of PCOS

Aside from abdominal fat, symptoms of PCOS include: ¹

• Hirsutism: Excess body or facial hair in women, especially on the chin, upper lip, chest, and back.
• Acne: Pimples on the face, chest, and back.
• Irregular menstrual cycles: Longer, shorter, or missing periods.
• Infertility: Difficulty conceiving due to irregular menstrual cycles or missing periods.
• Mood changes: Anxiety, depression, or irritability.
• Thinning hair: Hair loss on the scalp or thinning of the eyebrows.

What are the Health Risks of PCOS?

The metabolic disruptions associated with abdominal fat include blood sugar dysregulation, increased risk for heart disease, and type 2 diabetes. These risks are increased for people with PCOS. It's estimated that around 50% of women with PCOS in the United States have metabolic syndrome. 

Research suggests that central obesity is more of a health risk than carrying body fat evenly throughout the body. As a result, some scientists suggest that measuring the waist-to-hip ratio is a far more useful tool for predicting metabolic health than BMI.

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How to Support a Healthy Weight with PCOS

No definitive cure for PCOS exists, but natural solutions can support symptom management. People with PCOS are often prescribed birth control pills or blood sugar medications like metformin, but lifestyle habits can also be effective.

A holistic approach that includes nutrition, targeted supplementation, stress management, and regular exercise can help people with PCOS improve their overall health and well-being. Addressing the root causes of hormonal imbalances and inflammation helps women with the challenges associated with PCOS.

Dietary Approaches to Target PCOS

Nutrition plays a significant role in PCOS symptom management. A diet low in sugar and refined carbohydrates, emphasizing low-glycemic carbs, lean proteins, healthy fats, and high-fiber whole grains, can help address inflammation and blood sugar balance.

You don't need to follow a specific diet plan necessarily, but if you need help to get started, the following approaches may be beneficial:

• The Mediterranean Diet: This dietary pattern emphasizes plant-based foods, small amounts of animal proteins, healthy fats like olive oil, lean proteins, and whole grains while avoiding processed foods.

• DASH Diet: The Dietary Approaches to Stop Hypertension (DASH) isn't just for high blood pressure. It includes foods high in potassium, fruits and vegetables, lean proteins, low-fat dairy products, and whole grains while limiting sodium intake. The DASH diet is also linked to improved heart health, weight loss, and reduced inflammation.

You may have also heard that people with PCOS need to avoid gluten and dairy. While some people may be sensitive to these foods and benefit from avoiding them, there is no clear evidence that everyone with PCOS should avoid them.

5 Exercises for PCOS 

Exercises for PCOS are no different than for anyone else. They should be targeted to your specific needs and goals, but exercise is essential to PCOS management. A well-rounded program should include strength training, aerobic exercise, balance and coordination exercises such as:

• Resistance training: Resistance training supports lean body mass to increase metabolic rate for weight loss, maintenance, and insulin sensitivity.

• HIIT (high-intensity interval training): HIIT is great for burning fat and improving cardiovascular fitness.

• Yoga: Yoga can help reduce stress, improve flexibility, balance, and physical strength. 

• Pilates: Pilates supports core strength, balance, and flexibility.

• Walking: Walking, especially after meals, can help regulate blood sugar levels. 

One note about HIIT exercise: if you are stressed or have high cortisol levels due to PCOS, HIIT may not be your best choice, at least temporarily. Whether HIIT is right for you requires a conversation with a personal trainer who understands PCOS and its specific effects on your body.

6 Effective Tips for Achieving a Healthy Weight with PCOS

Not sure where to start? Try these six tips for getting back on track with your health goals and achieving a healthy weight when living with PCOS:

1. Eat plenty of fiber-rich foods. High-fiber, nutrient-dense foods are key for managing PCOS symptoms and keeping blood sugar in check. Fiber also helps promote satiety and support digestive health.

2. Get enough rest. Sleep is essential for balancing blood sugar and hormones. Make sure to get 7-9 hours of quality sleep each night.

3. Exercise regularly. Aim for at least 30 minutes of moderate-intensity exercise daily, such as walking, swimming, biking, and yoga. Take rests or low-impact days as needed.

4. Manage stress. High stress levels can make maintaining healthy blood sugar levels and hormones harder. Stress hormones spike blood sugar and also increase abdominal fat. To manage stress levels, try mindfulness techniques like meditation or breathing exercises.

5. Try Inositol. Inositol is a supplement that may help reduce symptoms of PCOS. Studies show inositol supports the menstrual cycle, fertility, and insulin resistance.²¹ Always check with your healthcare practitioner before starting a new supplement.

6. Track blood sugar levels. Keeping a log or using a continuous glucose monitor (CGM) can help you to manage blood sugar levels by seeing how you respond to food, exercise, sleep, and stress. You can then use this data to make necessary dietary or lifestyle changes.

FAQs About PCOS Belly

What happens if PCOS is left untreated? 

If PCOS is left untreated, it can lead to various health issues, such as infertility, miscarriage, diabetes, and heart disease. Luckily lifestyle changes, such as diet and exercise, significantly reduce the risk of all these conditions.

Can PCOS go away with weight loss? 

PCOS never goes away, but weight loss may help to reduce the symptoms of PCOS. Losing just 5% of your body weight can improve metabolic function, reducing the risk of long-term health complications. However, you can also improve symptoms of PCOS without significant weight loss.

Is it possible to have a flat tummy with PCOS? 

Not everyone with PCOS will have a "PCOS belly," but some do. It's less critical to have a perfectly flat stomach and more important to learn about your metabolic health and the effects of PCOS on your body. When issues like insulin resistance and elevated androgens are addressed, abdominal weight may be reduced.

• <p class="pro-tip"><strong>Keep reading: </strong> <a href="/blog/pcos-pms-and-perimenopause">PCOS, PMS and Perimenopause, What Role Does Glucose Play?</a>.</p>

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