Overcoming PCOS Weight Loss Challenges

If you have polycystic ovary syndrome (PCOS) and struggle to lose weight, you are not alone. While weight loss with PCOS may be slower and may require medical support, it is possible and can improve symptoms. 

What Is PCOS?

PCOS is a common endocrine disorder that affects between 6% and 12% of women.¹ PCOS is the most common cause of anovulatory infertility in women. Other symptoms of PCOS include:

• Irregular menstrual cycles
• Excessive hair growth on the face, chest, abdomen, and upper thighs
• Severe acne
• Acanthosis nigricans which are patches of thickened, velvety, darkened skin

Women with polycystic ovary syndrome have an increased risk of:

• Infertility 
• Obesity
• Insulin resistance
• Type 2 diabetes mellitus
• Abnormal blood lipids
• Uterine cancer
• Cardiovascular disease
• Sleep apnea
• Depression

A PCOS diagnosis depends on having at least two of the following:

• Increased androgens 
• Irregular menstrual cycles 
• Polycystic ovaries

The cause of PCOS is not fully known but is likely due to a combination of genetic and environmental factors.² One other aspect of this condition is that PCOS is highly heritable. Several genes have been identified that increase the risk of having PCOS.³ 

Approximately one-fourth of women with PCOS have mothers with the condition, and one-third have sisters with PCOS.⁴ First-degree relatives of women with PCOS are more likely to have insulin resistance, regardless of sex.²

What is insulin resistance? 

Insulin resistance means that body cells do not respond to insulin as well as they should, causing glucose levels in the blood to increase. The pancreas responds by producing more insulin. 

After you consume carbohydrate-containing foods and drinks, your pancreas releases insulin to shuttle glucose from your bloodstream into your cells. Insulin is also released in response to eating fat and proteins. If glucose is not used by your cells as a source of energy, it is stored as glycogen in the liver, muscles, and brain cells. Excess glucose is stored in fat (adipose) cells when glycogen stores are full. 

Blood glucose will rise if the pancreas cannot produce enough insulin to move glucose from the bloodstream into cells. When your blood glucose levels rise despite increased insulin levels, you may develop type 2 diabetes mellitus. 

<p class="pro-tip"><strong>Learn about </strong><a href="/blog/insulin-resistance-vs-prediabetes">insulin resistance vs. pre diabetes</a></p>

Why it can be harder to lose weight when you have PCOS

The cause-and-effect relationship between polycystic ovary syndrome, obesity, and insulin resistance is not fully understood, but researchers believe PCOS is likely due to having a genetic predisposition combined with lifestyle choices. Research on PCOS is still in its early stages. 

PCOS increases insulin resistance

Most women with PCOS, even those at a healthy weight, have some degree of insulin resistance.³ Researchers have found abnormalities in the insulin-signaling mechanism that causes PCOS-induced insulin resistance, but the abnormalities are not consistent in all people with PCOS. Insulin resistance directly from PCOS can be further exacerbated by insulin resistance from overweight and obesity.⁵ 

PCOS causes several metabolic problems, including:²

• Lack of metabolic flexibility, which is a reduced ability to switch between using carbohydrates and fats for energy
• Poor glucose control
• Insulin resistance while fasting and after a glucose load
• A 25% reduction in insulin sensitivity

Combined, these factors increase the risk of developing type 2 diabetes by four to eight times.⁶

<p class="pro-tip"><strong>Learn about </strong><a href="/blog/benefits-stable-glucose">the benefits of stable blood sugar</a></p>

Insulin resistance increases androgen production

Insulin resistance increases androgen production and reduces sex-hormone binding globulin, which further increases androgens. 

Androgen excess causes increased organ and abdominal fat, LDL (bad) cholesterol, and fatty acids. ³ In addition to increased abdominal fat, one study showed that women with PCOS, with or without obesity, had larger fat cells than women without the condition.⁷ 

Increased androgens worsen insulin resistance

Fat can be stored under the skin as subcutaneous fat or around the organs as visceral fat. Excess fat is stored in the abdomen in men and postmenopausal women due to androgen dominance. Estrogens cause fat to be stored more in the hips and buttocks. 

Visceral fat has a more direct blood supply to the liver than subcutaneous fat. Increased visceral fat increases insulin resistance. 

Weight loss can improve insulin resistance and PCOS symptoms

Weight loss, even 5% of your body weight, improves insulin sensitivity and reduces androgen levels.^3,5,8,9

Weight loss for women with PCOS is more difficult than for women without the condition. Feedback loops drive increased androgens and insulin levels, which makes it more difficult to lose weight. However, successful weight loss can reduce the symptoms associated with PCOS.³

What's different about the approach to losing weight when you have PCOS?

High insulin levels tell your body that plenty of nutrients are available. Instead of breaking down stored glycogen and fats, your body focuses on storing nutrients.  

Insulin resistance makes it more difficult for glucose in the bloodstream to get into cells, where it can be used for energy. So, even though plenty of glucose is available, body cells signal the brain that they need more nutrition. Your brain responds to these signals by increasing hunger and cravings, especially for carbohydrates. 

Women with PCOS also have lower levels of the peptide hormone ghrelin, a hormone that regulates appetite and body weight. Ghrelin levels decrease after a meal to tell your brain you are full and satisfied. Women with PCOS have lower fasting ghrelin levels and lower reductions in ghrelin after eating. The result is less satiety, more hunger, and weight gain.⁷

Women with PCOS deal with cravings, excess hunger, blood sugar spikes, and insulin resistance. Avoiding simple carbohydrates in your diet and monitoring your body’s response to nutrients and exercise is essential. 

<p class="pro-tip"><strong>Learn about </strong><a href="/blog/signs-of-hunger">hunger signals and blood glucose</a></p>

7 Tips for Losing Weight with PCOS 

Losing weight with PCOS starts with lifestyle modifications, but additional support may be needed using insulin-sensitizing and anti-androgen medications. Other medical conditions may be the result of or contribute to PCOS. Treating these conditions may help with weight loss. 

1. Treat obstructive sleep apnea

Obstructive sleep apnea is characterized by recurrent episodes of complete or partial airway obstruction while you sleep. It leads to intermittent low levels of oxygen and frequent nighttime awakenings. People with obstructive sleep apnea have an increased risk of insulin resistance. 

Obstructive sleep apnea is more common in women with PCOS. A longitudinal study showed that women with PCOS have a 2.26 higher risk of developing obstructive sleep apnea than women without the condition, regardless of body mass index or age. ¹⁰

Symptoms of obstructive sleep apnea include:

• Snoring
• Excessive daytime sleepiness
• Morning headaches
• Awakening at night, gasping or choking

If you have symptoms of obstructive sleep apnea, contact your healthcare provider for treatment options. Improving sleep can help with weight loss. 

<p class="pro-tip"><strong>Learn about </strong><a href="/blog/improving-sleep-quality-how-to-not-wake-up-tired">improving sleep quality</a></p>

2. Take care of your mental health

PCOS symptoms can cause many women to struggle with anxiety and depression. In one study, women with PCOS reported higher levels of anxiety, depression, and negative self-image than women without the condition.¹¹ Other studies show similar results. ^12,13

Anxiety and depression can sabotage your attempts to make lifestyle modifications that lead to successful weight loss. Medications used to treat anxiety and depression can also contribute to weight gain, but there are options that don’t. 

If you have anxiety or depression, contact your healthcare provider for treatment options.

<p class="pro-tip"><strong>Learn about </strong><a href="/blog/medications-weight-gain">medications that can cause weight gain</a></p>

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3. Increase physical activity

Increasing physical activity throughout the day can help improve:⁸

• Weight management
• Fasting insulin levels
• Blood pressure
• Cardiovascular health
• Mood
• Sleep quality
• Reproductive function

In one study, women with PCOS who performed progressive resistance exercise for four months had reduced androgens and fasting glucose.¹⁴ Fasting glucose levels are your glucose levels first thing in the morning. Impaired fasting glucose is a sign of insulin resistance. 

In another study, structured exercise for three months led to a 4.5% reduction in body mass index and an improvement in insulin resistance.¹⁵

Overexercise can negatively affect ovulation and reproduction. Aim for 150 minutes of exercise each week. Choose activities you enjoy and incorporate them into your daily schedule.

• Both cardio and resistance exercise can help reduce abdominal fat and increase insulin sensitivity. 
• Cardio can improve sleep, reduce anxiety, and improve mood. 
• High-intensity interval training (HIIT) involves short bursts of high-intensity exercise followed by lower-intensity recovery. HIIT can help with weight loss and insulin sensitivity. 

<p class="pro-tip"><strong>Learn about </strong><a href="/topics/hiit">getting started with HIIT</a></p>

4. Reduce carbohydrate intake

In a crossover study, women with PCOS, obesity, and insulin resistance followed a three-week diet containing 40% carbohydrates, 45% fats, and 15% protein. This was followed by a three-week diet containing 60% carbohydrates, 25% fats, and 15% protein. Blood sugar levels were similar on both diets, but daily insulin concentrations were 30% lower on the lower carbohydrate, higher fat diet. ¹⁶ Two clinical trials showed similar results.¹⁷

Some experts suggest replacing calories from carbohydrates with proteins. Increasing protein in your diet can help stabilize blood sugar, increase feelings of fullness, and reduce cravings. ¹⁸

<p class="pro-tip"><strong>Learn more about </strong><a href="/blog/protein-for-weight-loss">why protein can help you lose weight</a></p>

5. Choose low-glycemic foods

The glycemic index measures how much a food raises blood sugar.

• High glycemic foods (70-100) cause higher spikes in blood glucose more quickly
• Medium glycemic foods (50-69) cause lower spikes
• Low glycemic foods (20-49) cause the lowest spikes or none at all

In one study, women with PCOS consumed a diet rich in low-glycemic foods for 12 weeks, followed by their regular diet for 12 weeks. Insulin sensitivity improved while they consumed foods with a low-glycemic index.¹⁹ 

Signos guides to help you choose low-glycemic foods: 

<ul><li>Top Low-Glycemic Fruits</li><li>Top Low-Glycemic Vegetables</li><li>Low-Glycemic Snack Ideas</li><li>5 Easy Low-Glycemic Dinner Recipes</li></ul></div>

6. Increase fiber intake

Fiber can help you feel fuller for longer with fewer calories. Choose whole grains over refined. Researchers found that the average daily intake of whole-grain fiber contributed 15.3% to the American diet. Adults should consume between 25 and 35 grams of fiber per day, a recommendation that only 3% of the population meets.²⁰ 

In one study, the diets of women with PCOS were compared with those without. There was an inverse relationship between dietary fiber intake and total body fat. Increased fiber intake can improve body composition and glucose metabolism. ²¹

<p class="pro-tip"><strong>Learn about </strong><a href="/blog/high-fiber-low-carb-foods">the benefits of high-fiber low-carb foods</a></p>

7. Eat more fermented foods

In one study, gut bacteria diversity was reduced in women, especially those with PCOS, compared to men. Correlations between some strains of bacteria and androgen levels suggest that gut bacteria may also play a role in weight gain. ²² Although the research is not robust enough to make a recommendation, ask your healthcare provider whether probiotics and fermented foods may be beneficial for you. 

What to Avoid if You Have PCOS and Want to Lose Weight

PCOS is a complex disorder. There is not a one-size-fits-all solution. It is easy to get frustrated when you are eating healthy and exercising and still aren't losing weight. Keep in mind that a healthy diet and exercise benefit your overall health. 

Avoid refined carbohydrates. Besides causing blood sugar spikes, they can cause inflammation and worsen insulin resistance. 

Don't restrict your diet too much or under-eat. Calorie restriction may cause short-term weight loss, but it is not sustainable and can cause other health problems. 

Lack of sleep and increased stress can lead to weight gain, undermining your efforts. Instead, try mindfulness, yoga, spending time outdoors, and breathing exercises to help manage stress. 

<p class="pro-tip"><strong>Learn about </strong><a href="/blog/sustainable-weight-loss">the benefits of sustainable weight loss</a></p>

Are There Supplements or Medications That Help People with PCOS Lose Weight?

Short answer: maybe. Some research suggests that supplements like myoinositol and carnitine may help with weight loss. Myoinositol increases insulin sensitivity. However, studies so far do not show that it has any significant benefit for treating insulin resistance. 

There are very few FDA-approved medications for treating symptoms of PCOS, leading many prescribers to use medications off-label. 

Metformin is used to treat type 2 diabetes mellitus but may help with insulin resistance by increasing insulin sensitivity.²³ Prescription medications that increase insulin sensitivity may also help with weight loss. More research is needed.²⁴

When to Talk to a Doctor About Weight Loss

Talk to your doctor if you have tried lifestyle management (diet low in sugar and saturated fats, and regular exercise) and are not seeing the results you expect. Medications are available to increase insulin sensitivity. There are also many safe and effective medications to help with weight loss. Consider asking for a referral to a PCOS specialist and a dietician for help planning a healthy diet. 

Most importantly, be patient with yourself as you make lifestyle changes, especially if you are newly diagnosed with PCOS.