Polycystic ovarian syndrome (PCOS) is a complex hormonal disorder that affects women of reproductive age. According to the World Health Organization (WHO), up to 13% of all women have PCOS and another 70% are believed to be undiagnosed. Occurrences of PCOS are rising so rapidly that the overall market of PCOS drugs is expanding significantly and is likely to reach a compound annual growth rate (CAGR) of 4.7% within a projected period of eight years.
While it is commonly known that PCOS can affect fertility and menstrual cycle, it is crucial to recognize that it also has a significant impact on weight-related issues. In fact, the interplay between PCOS and weight is a vicious cycle, with one affecting the other in drastic ways.
How weight affects PCOS
Evidence suggests a strong association between weight and PCOS, with overweight and obese women being more likely to develop the syndrome. In addition, weight has a direct influence on the severity of PCOS symptoms. This is because being overweight or obese is often accompanied by insulin resistance, which leads to compensatory hyperinsulinemia—increased insulin production. Hyperinsulinemia contributes to higher androgen production in the ovaries and adrenal glands, which is a characteristic of PCOS.
Excess adipose tissues also secrete leptin, which leads to hormonal imbalances. Leptin plays a crucial role in regulating appetite, energy metabolism, and reproductive function. Its elevated levels of obesity disrupt the hypothalamic-pituitary-ovarian axis, leading to hormonal imbalances seen in PCOS. Furthermore, elevated leptin has been associated with increased androgen production in the ovaries, thereby contributing to the development and aggravation of PCOS symptoms.
Additionally, adipose tissue in overweight and obese individuals is characterized by increased macrophage infiltration, leading to chronic low-grade inflammation. This inflammation disrupts the balance of key hormones like insulin and adiponectin, which in turn affects ovarian function and contributes to PCOS pathogenesis. Oxidative stress also increases in the adipose tissue due to cellular damage. This similarly affects ovarian function, as well as contributes to insulin resistance and inflammatory dysregulation—all of which are implications of PCOS development.
How PCOS affects weight
One of the primary ways in which PCOS affects weight is through weight gain. The majority of women with PCOS exhibit the aforementioned insulin resistance, wherein their bodies are less responsive to the hormone’s effects. Consequently, the pancreas compensates by producing more insulin to maintain normal blood sugar levels. Excess insulin promotes fat storage and hampers fat breakdown, leading to weight gain. This hormonal imbalance also causes increased appetite, particularly for carbohydrates, which further aggravates weight gain among women with PCOS.
Those diagnosed with PCOS also experience more difficulties when it comes to managing their weight. This is because elevated levels of androgen, such as testosterone, is a hallmark of PCOS. These hormones influence metabolism and body composition, favoring weight gain and android fat distribution. Androgens can also impair the breakdown of fats, leading to increased fat storage and a higher percentage of visceral fat.
Interventions to address PCOS and weight
While in no way a new intervention, nutritional intake is continuously being studied as a primary solution for PCOS-related weight gain. Currently, one of the most important aspects of a PCOS diet for weight loss is opting for foods rich in fiber and have low glycemic index (GI) carbohydrates. This is because carbohydrates should not actually be eliminated from diets but rather controlled. Foods like whole grains, legumes, and fruits have a slower impact on blood sugar levels, preventing spikes and crashes common in PCOS. Fiber is also great for weight management as it can influence feelings of hunger and satiation. In addition, PCOS diets should prioritize lean proteins that help stabilize blood sugar levels and increase satiety. This reduces any cravings and lessens the chances of overeating. Sources of lean protein include poultry, fish, eggs, and low-fat dairy products.
Exercise is another pivotal intervention when it comes to addressing PCOS and weight. Regular physical activity helps reduce insulin resistance, promote weight loss, and improve overall health. Implementing exercises to help address PCOS such as cardio, strength training, and high-intensity interval training (HIIT) can enhance insulin sensitivity and support weight management. Moreover, engaging in regular exercise has been proven to have numerous positive effects on mood and mental health, which are often affected by the PCOS condition.
