PCOS and Weight Loss: What to Know

Craig Primack MD

Reviewed by Craig Primack, MD, FACP, FAAP, FOMA

Written by Lauren Panoff

Published 04/16/2024

Polycystic ovary syndrome (PCOS) is a hormonal disorder commonly diagnosed in women of childbearing age.

While PCOS isn’t an outwardly apparent condition, it can wreak havoc on physical and emotional health for many women. One of the most common complaints is that having PCOS can make it difficult to lose weight, a symptom that is generally related to imbalanced hormones.

Weight loss can be more challenging with PCOS, but that doesn’t mean it’s impossible. We’re laying out everything you need to know about how to lose weight with PCOS.

PCOS is characterized by an imbalance in hormones, including:

  • Androgens: These are often referred to as "male hormones," although both men and women produce them. People with PCOS typically have an excess of androgens like testosterone.

  • Insulin: Many women with PCOS have insulin resistance, which means their cells don't respond effectively to insulin. This leads to high insulin levels in the blood, which can stimulate the ovaries to produce more androgens and exacerbate hormonal imbalances.

  • Estrogens: While estrogen levels can vary in PCOS, some women may have more estrogen than progesterone due to irregular ovulation.

  • Progesterone: Women with PCOS often have low levels of progesterone, as irregular ovulation leads to fewer cycles where progesterone is produced after ovulation.

The word “polycystic” in polycystic ovary syndrome refers to the development of multiple cysts on a woman’s ovaries. These result from follicles in the ovaries that fail to release eggs regularly because of these hormone imbalances.

Other symptoms of PCOS can include:

  • Irregular menstrual cycles

  • Heavy or long periods

  • Excess hair growth (hirsutism)

  • Skin changes and acne

  • Higher body mass index (BMI), obesity and difficulty losing weight

  • Infertility or trouble getting pregnant

Unfortunately, PCOS can also lead to a higher risk of developing obesity-related health conditions like type 2 diabetes and cardiovascular disease.

While the exact cause of PCOS remains unclear, genetics, insulin resistance and inflammation are believed to be key factors.

Managing PCOS typically involves a combination of lifestyle changes, medications to regulate hormones and, sometimes, fertility treatments for those trying to conceive.

Thanks to hormonal imbalances and other metabolic issues, many women with PCOS find it very hard to lose weight. If this describes your experience, we want to start by acknowledging how frustrating it can be.

The good news is that weight loss with PCOS is absolutely possible with a comprehensive approach.

Adopting a lifestyle with regular movement and a nutrient-rich diet can be particularly beneficial. Plus, these habits are invaluable for your overall wellness.

Additionally, some women with PCOS may benefit from medications or supplements prescribed by their healthcare provider to help manage symptoms and support weight loss.

While losing weight with PCOS may require patience and persistence, it can significantly improve your symptoms and overall health outcomes.

Consult a healthcare provider or dietitian specializing in PCOS management and women's health for personalized treatment options.

Why Does PCOS Cause Weight Gain?

The body is a complex system and several interconnected mechanisms can make it harder to lose weight when you have PCOS.

First, insulin resistance is common in PCOS. To understand what this means, let’s start by breaking down how insulin is supposed to work.

When you eat, your body digests carbohydrates into sugar (glucose) molecules that travel to your bloodstream. In response, your pancreas releases insulin, which helps glucose get into your cells to be used for energy.

In insulin resistance, however, cells don’t respond as well to insulin and sugar is left in your blood, resulting in prolonged high blood sugar levels. The pancreas continues to attempt to produce more insulin, resulting in high levels of insulin in your blood.

Insulin resistance can promote fat storage, particularly around the abdomen, and make it harder for your body to use stored fat for energy. High insulin levels can also stimulate your ovaries to produce more androgens, further disrupting hormonal balance and promoting weight gain.

In addition, the hormonal imbalances in PCOS (high levels of androgens and lower levels of female hormones) can influence metabolism in a way that encourages more fat accumulation.

Finally, having irregular periods and associated hormone fluctuations can trigger cravings for calorie-dense foods and cause trouble managing appetite.

Good nutrition is essential for PCOS management and overall health.

There’s no “perfect” diet or macronutrient makeup for PCOS management. A dietary pattern that prioritizes minimally processed and whole foods — and avoids ultra-processed foods — is the best way to get a variety of essential nutrients.

Prioritizing these foods also helps support healthy blood sugar regulation, hormonal balance and weight management.

Add these foods to your plate to help manage your PCOS:

  • Non-starchy vegetables: Incorporating plenty of leafy greens, broccoli, tomatoes, mushrooms and bell peppers can provide essential vitamins, minerals and fiber. This will keep you full while keeping your calorie and carb intake in check.

  • Complex carbohydrates: Fiber helps promote satiety and prevent spikes in blood sugar levels. Great sources include high-fiber whole grains, legumes (beans, peas and lentils) and sweet potatoes.

  • Lean proteins: Protein from lean sources like poultry, fish, tofu, tempeh and beans can help you manage your appetite and preserve lean muscle mass.

  • Healthy fats: Get healthy unsaturated fats — which can benefit hormone production — from foods like avocados, nuts, seeds, hummus and olive oil.

  • Antioxidants: Antioxidants help protect your cells from stress, inflammation and damage that can cause disease. Choose a variety of colorful berries, fatty fish, turmeric, dark chocolate and green tea.

As for foods to avoid with PCOS, ultra-processed foods tend to be high in saturated fat, sodium and/or added sugar. They’re also usually low in fiber, vitamins, minerals and antioxidants.

Examples of ultra-processed foods include:

  • Pastries, cookies and donuts

  • Candy

  • Soda

  • Fruit juice

  • Energy and sports drinks

  • Packaged snacks and cereals made with refined white flour

  • White bread, white rice and pasta made with refined white flour

  • Processed meats, like bacon and hot dogs

One meal or day of ultra-processed foods won't make or break your health. However, eating these foods frequently can promote inflammation, hormonal imbalance and weight gain.

Additionally, you should limit saturated fat, which primarily comes from animal-derived sources.

Researchers recommend eating smaller meals throughout the day to help manage your appetite and blood sugar levels. If you have obesity, your healthcare provider may recommend a calorie deficit to help promote weight loss. Usually, you’ll eat around 500-750 calories less than you need to maintain your current weight.

For personalized guidance on creating a PCOS diet plan, meet with a registered dietitian or medical provider knowledgeable in PCOS management and healthy weight loss.

Prescribed online

Weight loss treatment that puts you first

The best way to manage PCOS-related weight gain? Keep it simple by focusing on everyday lifestyle habits.

If you have obesity, the first line of treatment is usually lifestyle modification. If you have insulin resistance, your healthcare provider may prioritize medication — typically metformin.

Research shows that women with PCOS who achieve a healthy weight via lifestyle changes have a better quality of life and fewer medical complications associated with PCOS.

More Movement

Nutrition and physical activity go hand in hand for overall health and weight management, regardless of whether PCOS is involved. Exercise can also help improve insulin sensitivity and reduce the risk of health complications associated with PCOS, like heart disease and diabetes.

Experts recommend at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity each week, and muscle-strengthening activities two or more days per week.

To get your minutes and steps in, rotate a combination of activities you enjoy, like walking, jogging, swimming, biking, playing tennis or joining a high-intensity group fitness class.

Strength training exercises can include weightlifting, using resistance bands or doing bodyweight exercises to increase lean muscle mass, boost metabolism and support weight management.

If you’re new to exercise, start slowly and listen to your body as you gradually increase the intensity or duration of your workouts. Doing them with a friend or group can make it more enjoyable.

Hydration

Water is essential to health for many reasons, including PCOS management.

Staying well-hydrated helps regulate hormone levels, supports metabolism and aids in healthy weight maintenance. It can also help alleviate symptoms like fatigue and bloating and help your body flush out waste, digest fat and reduce inflammation.

Furthermore, staying hydrated can help regulate your appetite and prevent overeating, especially when you drink water right before or during meals and snacks.

Incorporating plenty of water-rich fruits and vegetables into your diet, along with regular water intake, can help you meet your daily hydration needs. If you get tired of plain water, try substituting plain seltzer, herbal teas or water flavored with lemon or cucumber slices occasionally.

Better Sleep

Sleep is time for your body to rest, repair and recharge. Getting enough sleep is essential for healthy hormone regulation, metabolism, weight management and overall health.

Sleep deprivation, on the other hand, is associated with unintentional weight gain. It can also disrupt hormones, particularly those involved in appetite, stress response and insulin sensitivity.

Not to mention that when you don’t sleep well, you can feel like garbage — which can exacerbate fatigue, mood swings and cravings.

Experts recommend adults get seven to nine hours of quality sleep per night. If this feels like a stretch, we get it — but there are some things you can do to help make quality sleep more feasible:

  • Follow a regular sleep-wake schedule

  • Adopt a relaxing bedtime routine you can look forward to

  • Create a sleep-promoting bedroom using things like comfy PJs, breathable bedding and white noise (if needed)

  • Avoid using screens close to bed, as the blue light can disrupt melatonin production and make it harder to fall asleep

  • If you think you have sleep apnea, consult your healthcare provider

Weight Loss Medications

When your extra weight isn’t budging with healthy lifestyle habits alone, you may find it helpful to talk to your healthcare provider about weight loss medications.

Weight loss medications work by either reducing appetite, blocking the absorption of certain nutrients or increasing energy expenditure (calories burned). They’re intended to be used alongside healthy habits, like a nutrient-rich diet and increased daily movement.

Some of the most widely used and effective weight loss medications include:

  • Metformin: Metformin works for weight loss by reducing insulin resistance, improving glycemic control and decreasing appetite. It’s especially helpful for people with conditions like PCOS or type 2 diabetes.

  • Topiramate: Topiramate targets brain chemicals involved in appetite regulation, leading to reduced food intake and increased feelings of fullness.

  • Contrave®: This is a combination of two medications with other primary uses: bupropion, which is an antidepressant and smoking cessation aid, and naltrexone, used to treat alcohol and opioid dependence. Together, they act on different areas of the brain to reduce food cravings and decrease appetite.

  • GLP-1 receptor agonists: These injectable medications mimic the action of GLP-1, a hormone naturally produced in your intestines in response to food intake. GLP-1 helps regulate blood sugar by stimulating insulin secretion, slowing digestion and suppressing glucagon secretion. GLP-1 medications, therefore, help keep your appetite in check.

Start here to explore custom weight loss kits through Hers, which may include any combination of the above, except for GLP-1s. And if you’re already taking metformin as part of your PCOS management, you’ll need a kit that doesn’t include it.

Not everyone is a good candidate for weight loss medications; our licensed providers will help you determine if you are.

PCOS weight gain is frustrating, but with a multifaceted approach to healthy habits, you can regain control of your health and wellness.

If you’re living with PCOS and stubborn weight loss, remember:

  • You’re not alone. Millions of women live with PCOS and the many challenges it can bring. If you’re struggling with weight loss for PCOS, know that you’re not alone, and it’s not your fault.

  • There are options. PCOS may present obstacles, but that doesn’t mean you’re defenseless against them. Healthy lifestyle habits, along with weight loss medications in some cases, can be very effective.

  • It’s about more than weight loss. The habits proven to support healthy weight management with PCOS are also good for your overall wellness. A combination of good nutrition, regular movement and regular sleep will serve your long-term wellness.

Looking for more guidance about managing PCOS from a licensed healthcare provider? Take our free weight loss assessment.

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