Takeaways:

• In women with PCOS, there are imbalances in the levels of several different hormones.

• Women with PCOS often find it especially difficult to lose excess weight.

• PCOS has a very strong association with insulin resistance.

• With higher levels of insulin in the blood, your body will store more of the food you eat as fat.

• As insulin makes you feel hungry, you’ll also tend to eat more.

• The first line of treatment is generally lifestyle changes.

• Because insulin resistance can make weight loss difficult, medications that increase insulin sensitivity can be helpful in this situation. 

Polycystic ovary syndrome, or PCOS, is a very common condition among premenopausal women. In women with PCOS, there are imbalances in the levels of several different hormones, leading to a variety of symptoms. Studies have found that between 6 and 20% of all females of reproductive age have PCOS.

This condition can cause a variety of health issues, including weight gain. Women with PCOS often find it especially difficult to lose excess weight, which can be frustrating. Why does this condition tend to cause weight gain? Most importantly, are there ways to help those with PCOS to achieve a healthy weight?

Symptoms of PCOS

Women with PCOS have increased levels of androgens, which are “male” hormones like testosterone. All women’s bodies produce some androgens, but the levels are higher in those with PCOS. These increased androgens lead to many of the symptoms of this condition. 

The symptoms of PCOS include:

• Irregular periods; periods may frequently be missed, and may be very light or very heavy

• Infertility

• Excess growth of body hair and facial hair

• Weight gain

• Acne

• Thinning hair

• Dark or thickened patches of skin on the back of the neck, in the armpits, in the groin area, and under the breasts

• Skin tags (small flaps of excess skin), often in the armpits and on the neck

• Enlarged ovaries, which contain multiple cysts (fluid-filled sacs)

PCOS can affect any female of reproductive age, which is after puberty and before menopause. It’s common for women to be diagnosed during their 20s and 30s, when they’re trying to get pregnant and find that they’re having trouble conceiving. However, older or younger women and teen girls can also have PCOS.

How PCOS is associated with weight gain

PCOS has a very strong association with insulin resistance. Insulin is a hormone that’s produced in the pancreas in response to increased blood sugar levels. It causes the body’s cells to take up excess sugar from the blood, and to use or store it. In people with insulin resistance, the body’s cells don’t respond to insulin very well. The same amount of insulin causes a much smaller effect than it normally would.

When the body isn’t responding to insulin, then the pancreas will increase its production of this hormone to compensate. This leads to higher levels of insulin in the blood in people with PCOS. Insulin promotes the storage of calories as fat, so when you have high levels of insulin, then your body will tend to put on more fat tissue. Even if you eat the same number of calories, it’s likely that more of them will be stored as fat. Insulin also increases hunger, which makes you tend to eat more. This gives your body even more calories to store as fat.

Studies have shown that insulin resistance occurs in 65 to 95% of all women with PCOS, including the vast majority of those who are overweight or obese.

Why is it more difficult to lose weight if you have PCOS?

Women with PCOS often struggle to lose excess weight. With higher levels of insulin in the blood, your body will store more of the food you eat as fat. In addition, because insulin makes you feel hungry, you’ll also tend to eat more. As a result of these issues, women with PCOS often find it that it’s particularly difficult to lose weight. 

Weight loss can be challenging for anyone, but for those with PCOS, it’s even more challenging because of their hormonal imbalances. Many women with PCOS have tried to lose weight, but they feel like their bodies are resisting their efforts. This can be a very frustrating situation.

Being overweight promotes insulin resistance. The insulin resistance then leads to higher levels of insulin in the blood. This makes you tend to gain even more weight, further worsening the problem of insulin resistance. This cycle can be difficult to break.

Treatment options for PCOS-related weight gain

For women experiencing PCOS-related weight gain, the first line of treatment is generally lifestyle changes. These include exercise as well as a healthy, lower-calorie, low-carbohydrate diet. Intermittent fasting may also work well for women with PCOS. If a woman has the right support and is able to stick to her lifestyle plan diligently, this is sometimes enough to help her achieve a healthy weight.

However, healthy lifestyle changes may not be enough for everyone, especially because insulin resistance can make weight loss difficult. Medications are often useful for treating PCOS. Some of the treatment options include:

• Medications that increase insulin sensitivity (such as metformin). When the body’s cells become more sensitive to insulin, the pancreas won’t need to make so much extra insulin. As insulin levels drop back into a more normal range, weight loss often becomes easier.

• Oral contraceptives. The estrogen and progesterone in these medications helps to balance out the effects of androgens like testosterone. Because women with PCOS have high levels of androgens, balancing their hormone levels can help to address many of the symptoms of the condition.

• Weight loss drugs, such as GLP-1RAs (for example, semaglutide). These medications mimic a naturally occurring hormone in the body. They help to prevent your blood sugar from rising too high, which can help regulate insulin secretion, making it easier to lose weight. In addition, they keep you feeling full for longer after a meal, which can be beneficial for weight loss.

If you suspect that PCOS might be making it difficult for you to lose weight, make an appointment to speak with a specialist. You might benefit from medications to help with insulin resistance. It can also be very helpful to receive support in creating and maintaining a healthy lifestyle plan.

Patients enrolled in our NOVI Optimum Plus program receive medical care from one of our specialist doctors, along with ongoing health coaching to help them make healthy lifestyle changes. If you’re having trouble losing weight, then addressing insulin resistance could make a difference, not only in supporting your weight loss journey but also for your overall health.