Did you know that polycystic ovary syndrome (PCOS) affects 6% to 12% of women in the United States?
That's approximately five million women, most between the ages of 20-60.
In addition to potentially affecting fertility, causing acne, and impacting periods, PCOS can also lead to weight gain or a difficulty losing weight. In fact, according to a 2010 study published in Obesity Managment, “between 40–80% of women with this condition are reported to be overweight or obese.”
In this article, we’ll cover the basics of PCOS, how it impacts your weight, and what treatment options there are for PCOS-related obesity.
What is PCOS?
Knowing what PCOS is can help you understand how to properly manage symptoms. PCOS is an endocrine disorder that affects hormones during a woman's reproductive age. Specifically, the ovaries in those affected by PCOS produce abnormal amounts of androgens (a type of male sex hormone).
Some women develop cysts on their ovaries, hence the name "polycystic", but the name can be misleading as some women never develop cysts.
Not only does PCOS affect fertility, but it can also,
- Stop periods or make them very irregular
- Cause stubborn hormonal acne
- Increase facial hair
- Cause skin darkening, particularly on the back of the neck, in your armpits, and under the breasts
- Lead to thinning hair or hair loss
- Cause skin tags
- Increase the likelihood of diabetes and high blood pressure
While in the past, PCOS was viewed primarily as a reproductive disorder, we now know that it can lead to other symptoms outside of infertility.
How to Get Diagnosed
If you've experienced irregular periods, trouble losing weight, and acne, you could have PCOS. It's best to see a physician, so they can provide an accurate diagnosis based on your symptoms, test results, and medical history.
There is no one test that can determine if you have PCOS. Most doctors will ask you about your symptoms, run lab work, and do a physical exam. They may also order a vaginal ultrasound, in order to get better imaging of your ovaries and uterus.
PCOS is sometimes hard to diagnose because different women experience a different combination of symptoms, some of which (like ovarian cysts) are hidden unless using special imaging tools.
More research is still being done to help discover what other symptoms polycystic ovary syndrome might affect.
PCOS and weight gain
While studies have explored the relationship between PCOS and obesity, it is still unclear whether PCOS causes obesity or if obesity leads to PCOS.
Currently, research supports that both conditions can exacerbate one another: The insulin resistance and hyperandrogenism that goes along with PCOS can lead to overweight and obesity. Obesity, in turn, can worsen reproductive abnormalities.
Why it’s important to treat PCOS-related obesity
Losing weight can improve symptoms of PCOS. Notably, weight loss can improve insulin levels and reduce androgen levels. Weight loss can also lead to improvements in fertility and help restore ovulation.
In addition, anyone with obesity is at a higher risk of developing other conditions like type 2 diabetes, high blood pressure, heart disease, stroke, fatty liver disease, and more. This means that those who develop PCOS-related obesity are also more likely to develop one or more of those obesity-related comorbidities.
So, in addition to positively impacting insulin and hormone levels, losing weight can also reduce the risk of developing obesity-related conditions.
In fact, a 2010 study from BMC Medicine found that a “modest weight loss of 5% to 10% of initial body weight has been demonstrated to improve many of the features of PCOS.”
However, PCOS can make weight loss harder.
Why losing weight can be hard if you have PCOS
Losing PCOS-related weight can be difficult because PCOS often leads to insulin resistance and inflammation.
If you have insulin resistance, the cells in your muscles, fat, and liver become more inefficient at taking in the glucose from your blood. In response, your pancreas pumps out even more insulin. Over time, insulin resistance can lead to an increase in blood sugar levels (hyperglycemia), and, eventually, the development of type 2 diabetes.
How to lose weight with PCOS
It can be frustrating to feel like you're putting in a lot of hard work but not seeing any results. Many people with PCOS get discouraged because they simply can't get the weight off or it just keeps coming back.
If you’re having a hard time losing weight because of PCOS-related weight gain, it’s likely not related to your willpower. Your biology is impacting your ability to lose weight.
But there’s hope! It is still possible to improve your weight loss even after a PCOS diagnosis.
Here are 3 complementary ways to treat PCOS-related obesity.
1) Prescription weight loss medications
PCOS patients are at a higher risk of developing prediabetes, which can lead to type 2 diabetes or metabolic syndrome if left untreated.
To assist with insulin resistance (and, subsequently, make weight loss easier), your clinician may prescribe Metformin.
Metformin works by improving the sensitivity of peripheral tissues to insulin, which reduces circulating insulin levels. This helps counteract insulin resistance.
In addition to its effects on insulin and glucose levels, which benefit PCOS patients with insulin resistance, Metformin can also reduce fatty tissue and help with weight loss.
As both a treatment for type 2 diabetes and weight loss, Metformin addresses both symptoms of PCOS and the common comorbidity of obesity. And it is relatively affordable: even without insurance, many pharmacies offer Metformin for under $10 for a one-month supply.
The most common side effects of Metformin are nausea, diarrhea, and decreased appetite.
Metformin is safe for patients who are pregnant or looking to become pregnant. It has even been seen to positively support ovulation in those with PCOS-cause anovulation.
Another good option for those looking to lose 15 - 20% of their body weight are GLP-1 medications.
GLP-1 stands for “glucagon-like peptide-1.” This class of medications works by mimicking a hormone in your gut, which reduces appetite and cravings. Originally a class of prescription drugs used for type 2 diabetes, there are now multiple GLP medications available for weight loss, specifically.
Two medications that are FDA-approved for weight loss are semaglutide (brand name: Wegovy) and liraglutide (brand name: Saxenda)
With their success in supporting sustainable and safe weight loss, GLP medications are a great option for PCOS patients, particularly those primarily looking to treat obesity. They help combat insulin resistance and make it easier for those with PCOS to treat their obesity.
2) Managing exercise
In addition to incorporating a prescription weight loss medication into your obesity treatment, it is important to also incorporate lifestyle changes.
Proper exercise can help reduce BMI, regulate insulin, and promote wellbeing.
When trying to lose weight, focus on creating a workout routine that you can be consistent with. Every little bit counts, and it's going to take time to see positive results.
You could start by walking for 15 - 30 minutes a day, or adding a dance break into your evening routine.
Learn more about easy ways to incorporate fitness into your weight loss routine.
Changing up your diet can also help regulate insulin and support mental and physical health. To avoid elevated blood sugar levels, the goal is to eat smaller portions of carbohydrates throughout the day, focusing on complex carbohydrates and whole grains while avoiding refined and processed carbohydrates. It’s also important to include a source of lean protein with snacks and meals and choose healthy fat sources (i.e. salmon and other fatty fish, olive and avocado oils, nuts and seeds, and avocado).
Low glycemic foods promote a steadier supply of insulin to help avoid spikes in insulin. They may also support weight loss if, overall, you’re eating fewer calories by switching to lower glycemic foods. In general, lower glycemic foods include most fruits and vegetables, legumes, dairy, whole grains, potatoes and sweet potatoes, and corn. Higher glycemic foods include white bread, processed foods like crackers and chips, desserts and sweets.
The University of Sydney has a great searchable database to help you determine the glycemic index of your meals.
Although there is no specific PCOS diet, eating smaller portions of complex carbohydrates and focusing on a well-rounded nutritious diet with lean protein, fruit, vegetables, and healthy fats can lead to improved weight and health outcomes.
Other treatments for PCOS
While medication and lifestyle changes can help treat PCOS-related obesity, it is important to also view your PCOS treatment holistically.
While there is no cure for polycystic ovary syndrome, there are a few types of treatment that can address non-weight aspects of the disease. These can help reduce the symptoms women with PCOS experience.
If you are not actively trying to get pregnant, birth control can be a great option for women with PCOS. It can help
- Regulate your menstrual cycle
- Lower the production of androgens (decreasing acne and body hair)
- Reduce your risk of ovarian or endometrial cancer — which those with PCOS are 2.7 times more likely to develop
In those with ovarian cysts, hormonal birth control also helps prevent cysts from forming. Birth control pills, patches, vaginal rings, shots, or a hormonal IUD are great options.
Spironolactone is a blood-pressure medication with anti-androgen properties, meaning it blocks androgen receptors and decreases the production of androgen from the ovaries and adrenal glands.
It is a useful medication for the treatment of PCOS for those who experience hyperandrogenism, or, abnormally high levels of male sex hormones, including testosterone.
Spironolactone is primarily helpful as an addition to birth control. For patients with PCOS, spironolactone can help treat excessive body hair (“hirsutism”) or unwanted hair loss. In addition, it is useful against hormonal acne that derives from hyperandrogenism.
Not every PCOS patient develops acne, but it is a very common symptom. Unfortunately, due to the increase in androgens that often comes with PCOS, the condition can cause severe and stubborn acne.
Cystic and pustular acne are the most common acne types seen in PCOS patients. Acne in those with PCOS is often difficult to get rid of because you must treat not just the skin but also the hormonal imbalance.
In addition to spironolactone, birth control and prescription acne medication can help reduce acne for those with PCOS.
Where to Get Treatment
Treating PCOS often requires an interdisciplinary team. It can feel daunting to manage your PCOS treatment journey.
Seeing your primary care physician is a good place to start. They will evaluate you for the condition, or refer you to someone who can.
Gynecologists and OBGYNs can help if a patient is dealing with irregular periods. They can prescribe birth control and check to see if you have developed ovarian cysts. They can also help if you're actively trying to get pregnant and having trouble.
Visiting a dermatologist is highly encouraged for PCOS patients dealing with stubborn acne, discoloration of the skin, and excess facial hair. Dermatologists can prescribe acne medications if over-the-counter treatments are ineffective.
If you’re looking for help specifically for weight loss, Sequence offers virtual consultations with board-certified clinicians. Our team is familiar with the unique challenges PCOS can have on weight loss, and we’ve helped many patients with PCOS treat their obesity.
Don't Get Discouraged
Living with PCOS can be frustrating. Talk with your doctor and discuss how you're doing and what symptoms you’re experiencing. There may be options you haven’t tried yet for managing your PCOS symptoms.
With more and more research being published about PCOS, there's hope that even more treatment options will become available.
When diet and exercise don't work on their own, it can be discouraging. There are medications that can help. We encourage you to talk to your doctor or book a consultation with one of our clinicians to discuss prescription weight loss treatments for PCOS.
In our guided weight loss program, we pair breakthrough, FDA-approved weight loss medications with care coordination and nutrition plans.
Our clinicians provide comprehensive support to determine what medications will work best for your biology.
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