Question: 

I have PCOS and carry weight around my belly. Why does this happen and what can I do about it?

Answered by Karen Carlson, MD, OB-GYN:

If you have polycystic ovary syndrome (PCOS) and carry weight around your midsection, you’re not alone. Many people with PCOS notice this pattern, commonly called “PCOS belly.” 

What is PCOS belly?

“PCOS belly” is a term used to describe the tendency for people with PCOS to carry excess weight around the abdomen. The weight gain is often linked to insulin resistance and hormonal imbalance that comes with PCOS.

PCOS can make weight gain easier and weight loss harder. This happens because of higher insulin levels, increased androgens (male hormones), and metabolic changes in your body. 

Why PCOS affects weight differently

When you have PCOS, the body often doesn’t respond to insulin the way it should. Insulin is the hormone that helps your cells use sugar for energy. When your cells don’t respond well to insulin, your body makes more of it to compensate. These higher insulin levels can lead to weight gain, especially around your belly.

The increased androgens that come with PCOS also play a role. These hormones can affect where your body stores fat, often leading to more abdominal weight gain.

What helps with weight loss in PCOS?

Weight loss with PCOS typically focuses on improving insulin sensitivity. Here’s what research shows can help:

• Regular physical activity is key, especially strength training. Building muscle helps your body use insulin more effectively. Aim for a mix of cardio and strength training several times a week.
• Balanced nutrition makes a big difference. Focus on getting adequate protein and fiber at each meal. These nutrients help keep your blood sugar stable and make you feel full longer. Limit highly processed carbohydrates, which can cause blood sugar spikes.
• Some supplements may help. Myo-inositol has been shown to improve insulin sensitivity and hormonal regulation in some people with PCOS. When combined with lifestyle changes, it may support weight management. Always talk to your provider before starting any supplements.

Even small changes matter

Here’s encouraging news: even modest weight loss of 5% to 10% of your body weight can significantly improve PCOS symptoms. If you weigh 180 pounds, that’s just nine to 18 pounds. This amount of weight loss can lead to more regular periods, clearer skin and improved fertility.

You don’t need to lose a dramatic amount of weight to see real benefits. Small, sustainable changes often work better than extreme diets.

Getting individualized help

PCOS affects everyone differently. What works for one person may not work as well for another. That’s why individualized medical guidance is so important.

In some cases, medication can be an important part of treatment. Metformin, for example, can help improve insulin sensitivity. Birth control pills or other medications might help regulate your hormones. These treatments work best when combined with lifestyle changes.