Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age. One prevalent symptom is weight gain, particularly around the abdomen. PCOS often triggers weight gain due to hormonal imbalances, notably elevated levels of insulin. In turn, elevated insulin levels stimulate the ovaries to produce excess androgens, contributing to weight accumulation, especially around the abdominal region. 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 it’s still possible to improve your weight loss even after a PCOS diagnosis. Managing PCOS symptoms and supporting weight loss involves a multifaceted approach. This article explores effective weight loss strategies for women with PCOS, including prescription medications, exercise, nutrition, stress management, and sleep hygiene.
Prescription Weight-Loss Medications
For those looking to lose a significant amount of their body weight, prescription weight-loss medications can be a good option. Here's a look at some common options:
- Metformin: 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 may also have a benefit on appetite levels. As a treatment for type 2 diabetes and weight loss, Metformin addresses both symptoms of PCOS and the common comorbidity of obesity. Metformin can also lower insulin and blood sugar levels in women with PCOS. As well as stimulating ovulation, encouraging regular monthly periods and lowering the risk of miscarriage, metformin can also have other long-term health benefits, such as lowering high cholesterol levels and reducing the risk of heart disease. Metformin is not licensed for treating PCOS in the UK, but because many women with PCOS have insulin resistance, it can be used "off-label" in certain circumstances to encourage fertility and control the symptoms of PCOS. Safe for patients who are pregnant or looking to become pregnant, it has even been seen to positively support ovulation in those with PCOS-caused anovulation, which occurs when the ovaries stop releasing eggs. Possible side effects of metformin include nausea, vomiting, stomach pain, diarrhoea and loss of appetite. As metformin can stimulate fertility, if you're considering using it for PCOS and not trying to get pregnant, make sure you use suitable contraception if you're sexually active.
- GLP-1 Medications: Another good option for those looking to lose a significant amount of their body weight is a GLP-1 medication. 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-1 medications available for weight loss. Three medications that are FDA-approved for weight loss are Zepbound (tirzepatide), Wegovy (semaglutide), and Saxenda (liraglutide). With their success in supporting sustainable and safe weight loss, GLP-1 medications are a great option for PCOS patients, particularly those primarily looking to treat obesity. By combating insulin resistance, they make it easier for those with PCOS to treat their weight. For example, in clinical trials of Zepbound (tirzepatide), participants lost an average of 21% of their body weight over 72 weeks at the highest dose.
- Orlistat: Medicines can also be used to treat some of the other problems associated with PCOS, including weight-loss medicine, such as orlistat, if you're overweight.
The Role of Inositol
Inositol is a naturally occurring compound that belongs to the vitamin B complex group, although it is not officially recognised as a vitamin. Inositol is also synthesised in the human body and plays a crucial role in cellular signalling, insulin sensitivity and neurotransmitter modulation. Inositol is believed to improve insulin sensitivity, addressing one of the key factors contributing to weight gain in PCOS. As inositol is found both in the body and in many foods, there are a couple of ways in which you can incorporate inositol into your daily routine. Although inositol is a natural sugar, inositol supplements contain a much higher quantity of myo-inositol than diet alone. The most common supplement recommendation is myo-inositol, like Inofolic Alpha and Inofolic AlphaPlus which are known for their potential benefits in addressing insulin resistance, a factor in PCOS-related weight gain. Another way you can incorporate inositol into your daily routine is to consume it through inositol-rich foods. Opt for nutritious choices like beans, lentils, nuts, seeds, and citrus fruits, which are naturally high in inositol. Whole grains, especially oats and wheat bran, also provide a good dietary source.
Exercise for PCOS Weight Management
In addition to incorporating a prescription weight-loss medication into your treatment, it is also important to incorporate lifestyle changes. Regular exercise is absolutely essential in managing PCOS and facilitating weight loss. Proper exercise can help reduce BMI, regulate insulin, and promote well-being. When trying to lose weight, focus on creating a workout routine that’s consistent. Every little bit counts, and it's going to take time to see positive results. You could start by walking for just 15 minutes a day. Simply, incorporate a mix of aerobic exercises, such as brisk walking or cycling, and strength training into your routine.
Nutrition and Diet for PCOS
Food is an important part of the treatment equation too. Although there is no specific PCOS diet, changing up how you eat can also help regulate insulin and support mental and physical health. Of course, maintaining a healthy diet is vital for managing PCOS and supporting weight loss. To avoid elevated blood sugar levels, eat smaller portions of carbohydrates throughout the day, prioritizing complex carbohydrates and whole grains. It’s also key to include a source of lean protein (such as chicken and turkey) 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). Try to eat nutrient-dense foods such as fruits, vegetables, lean proteins and whole grains. You should also practise portion control and limit refined sugars and processed foods. The basis of a Mediterranean diet is fresh food such as fruit, vegetables, whole grains, nuts, spices, legumes and olive oil. Extra virgin olive oil has the added benefit of being rich in healthy fats and helping to absorb fat-soluble vitamins. WeightWatchers can help guide to make the most nutritious food choices for you and your body - whether through GLP-1 Companion Program for people taking GLP-1 medications or the Points Program for those who are not. If you feel like you need additional guidance, WeightWatchers also provides access to registered dietitians with experience managing a range of health conditions through nutrition therapy, including PCOS.
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Stress Management
High stress levels can lead to increased weight gain and make it much harder for someone with PCOS to lose abdominal weight. That said, try to incorporate stress-reducing practices such as yoga, meditation, or deep breathing exercises into your routine. Reducing stress not only aids in weight management but also helps balance hormonal levels, alleviating PCOS symptoms.
Sleep Hygiene
Finally, you should be making sure that you get enough sleep each night. Aim for 7-9 hours of quality sleep each night to regulate hormonal balance and reduce stress. You should also establish a consistent sleep routine by going to bed and waking up at the same time daily. To do this, you must create a conducive sleep environment, minimising light and noise. Reducing symptoms of PCOS has never been more manageable.
Other Medications and Treatments for PCOS Symptoms
A number of medicines are available to treat different symptoms associated with PCOS.
- Irregular or absent periods: The contraceptive pill may be recommended to induce regular periods, or periods may be induced using an intermittent course of progestogen tablets (which are usually given every 3 to 4 months, but can be given monthly). This will also reduce the long-term risk of developing cancer of the womb lining (endometrial cancer) associated with not having regular periods. Other hormonal methods of contraception, such as an intrauterine system (IUS), will also reduce this risk by keeping the womb lining thin, but they may not cause periods.
- Fertility problems: A medicine called clomifene may be the first treatment recommended for women with PCOS who are trying to get pregnant. Clomifene encourages the monthly release of an egg from the ovaries (ovulation). If clomifene is unsuccessful in encouraging ovulation, another medicine called metformin may be recommended. Letrozole is sometimes used to stimulate ovulation instead of clomifene. This medicine can also be used for treating breast cancer. Use of letrozole for fertility treatment is "off-label". This means that the medicine's manufacturer has not applied for a licence for it to be used to treat PCOS. In other words, although letrozole is licensed for treating breast cancer, it does not have a license for treating PCOS. Doctors sometimes use an unlicensed medicine if they think it's likely to be effective and the benefits of treatment outweigh any associated risks. If you're unable to get pregnant despite taking oral medicines, a different type of medicine called gonadotrophins may be recommended. These are given by injection. There's a higher risk that they may overstimulate your ovaries and lead to multiple pregnancies.
- Unwanted hair growth and hair loss: The combined oral contraceptive pill is usually used to treat excessive hair growth (hirsutism) and hair loss (alopecia). A cream called eflornithine can also be used to slow down the growth of unwanted facial hair. This cream does not remove hair or cure unwanted facial hair, so you may wish to use it alongside a hair removal product. Improvement may be seen 4 to 8 weeks after treatment with this medicine. Eflornithine cream is not always available on the NHS because some local NHS authorities have decided it's not effective enough to justify NHS prescription. If you have unwanted hair growth, you may also want to remove the excess hair by using methods such as plucking, shaving, threading, creams or laser removal. Laser removal of facial hair may be available on the NHS in some parts of the UK. Sometimes medicines called anti-androgens may also be offered for excessive hair growth, which may include cyproterone acetate, spironolactone, flutamide, and finasteride. These medicines are not suitable if you are pregnant or trying to get pregnant. For hair loss from the head, a minoxidil cream may be recommended for use on the scalp. Minoxidil is not suitable if you are pregnant or trying to get pregnant.
- IVF treatment: If you have PCOS and medicines do not help you to get pregnant, you may be offered in vitro fertilisation (IVF) treatment. This involves eggs being collected from the ovaries and fertilised outside the womb.
Lifestyle Changes and Weight Loss
In overweight women, the symptoms and overall risk of developing long-term health problems from PCOS can be greatly improved by losing excess weight. Weight loss of just 5% can lead to a significant improvement in PCOS. You can find out whether you're a healthy weight by calculating your body mass index (BMI), which is a measurement of your weight in relation to your height. A normal BMI is between 18.5 and 24.9.
Pregnancy Risks with PCOS
If you have PCOS, you have a higher risk of pregnancy complications, such as high blood pressure (hypertension), pre-eclampsia, gestational diabetes and miscarriage. These risks are particularly high if you're obese.
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