If only I had a penny for every time a doctor told me to “eat less and exercise more.” As a woman with Polycystic Ovarian Syndrome (PCOS), I’ve struggled with my weight for my entire life. Weight loss with PCOS seems simple enough in theory, but anyone with the condition knows that to be far from the truth. The complex balance of hormones makes it exceedingly difficult to fight the flab. One study cited that 50-60% of women and teenage girls with PCOS are also obese. Losing weight with PCOS is a battle that can be tough, dare I say ruthless at times, but it is not impossible!
Let’s talk a little about the condition to better understand PCOS’s effects on the body:
PCOS is a condition that affects between 12-21% of women of reproductive age and causes symptoms such as irregular menstrual periods (absent or unpredictable periods), infertility, hirsutism (excess hair growth on the face, chest, abdomen, etc.), severe acne, fluid-filled cysts on the ovaries, weight gain, difficulty losing weight, abdominal pain, and others.
The cause of PCOS is unknown. Doctors do not know what specifically causes PCOS, though it does seem clear that PCOS is related to an increase in hormone levels called androgens. Put simply, androgens are male sex hormones. Women with PCOS often have extremely elevated levels of testosterone.
PCOS affects the body in its entirety, it’s effects are not confined to the reproductive system. Because PCOS is a total body condition, women with PCOS are at increased risk for Type II Diabetes, Cardiovascular Disease, and Metabolic Syndrome. At the age of 22, I was diagnosed with high cholesterol and triglycerides, despite the strict and healthy diet I’d kept to for the past several years. I was also told that because of my high cholesterol and triglycerides, I was at high risk for heart disease. At 22 years old. The severity of PCOS is not to be taken lightly. If I’d known then what I know now about the risk factors involved with having PCOS, I might have punched the next person that told me to ‘just eat less and exercise more’ square in the face.
PCOS is closely related to insulin resistance. Insulin resistance is worsened as other PCOS symptoms are worsened (especially as women gain additional weight, making it a vicious cycle). I see the term insulin resistance thrown around a lot, but rarely is it explained. So, what is insulin resistance? Insulin Resistance (IR for short) is a condition in which the cells in the body do not respond to the effects of insulin.
In the case of PCOS, the cells’ sensitivity to the effects of insulin are decreased. Because the body cannot respond to insulin, the body’s blood sugar levels begin to increase. This is because insulin’s job is to carry sugars (glucose) out of the blood. Once the body realizes that blood sugar is too high, it will signal for more insulin to be produced in order to decrease the amount of glucose in the blood. IR can lead to Type II Diabetes, which is why a large proportion of women with PCOS also have Type II Diabetes.
You don’t have to be obese to have PCOS. There are two ‘forms’ of PCOS. One form greatly affects a woman’s weight and can lead to obesity. Remember that 50-60% of women and teenage girls with PCOS are also obese. The other form is known as ‘lean’ form. Women with lean form PCOS are often thin, BUT STILL HAVE SOME LEVEL OF IR. Even if a woman has the lean form of PCOS, but leaves the condition untreated or does not take the proper precautions to manage the condition, it is still possible for her to develop chronic co-morbidities such as diabetes, inflammatory conditions, heart disease, and/or high levels of cholesterol/triglycerides.
One study cited that up to 75% of women with lean form PCOS have insulin resistance and about 50% have Metabolic Syndrome. According to Lori B. Sweeney, an endocrinologist and associate professor of medicine at Virginia Commonwealth University Health System, “Women who have PCOS need an average of 400 fewer calories than women who don’t have the condition.” Women with PCOS are also more likely to store carbs as fats because of the mechanism behind IR.
Another statistic to consider is that women with PCOS are more likely to suffer from depression, anxiety, poor self-esteem, eating disorders, and sexual dysfunction. For most women with PCOS, that also suffer from anxiety or depression, the thought of getting out to exercise is exhausting in and of itself.
Anecdotally, I’ve also found that many women with the condition suffer from fatigue and are sorely lacking in energy throughout the day. This is something that I, myself experience. Struggling with fatigue certainly does not help with getting oneself motivated for the gym, I can tell you that from experience. I’ve also found that frustration from a lack of results after months (or even years) of eating right and exercising is extremely discouraging and can certainly contribute to a lack of desire to continue to eat healthy and exercise.
There are several different diagnostic criteria for PCOS, and PCOS can very difficult to diagnose. This is, in part, because many of the symptoms of PCOS are non-specific due to the inflammatory response that the condition triggers in the body. Additionally, the symptoms of PCOS often mask the larger issue at hand. When women first lose their period or experience weight gain, rarely do they assume that it is due to PCOS and IR/increased androgens (nor do their doctors for that matter, though this has certainly improved as PCOS continues to gain awareness).
When I first lost my cycle, I was told that stress was the culprit. It seemed strange to me that after a few years of regular cycles (I was diagnosed at the age of 15), stress would suddenly cause my cycle to just stop completely. I also suffered from years of severe pain caused from the cysts and extremely heavy and painful periods that would essentially force me to stay in bed for days. Fatigue, pain, frustration – I mentioned this to my doctors but no one saw the truth until I’d been to several specialists and had done my own research. At 15, I realized that I had to be my own advocate because my doctors weren’t listening to what I was telling them. One of my major concerns was that the longer PCOS is left untreated, the more difficult it can be to reverse.
The cycle of IR is perpetually worsened, and weight gain tends to follow as IR and hormonal imbalances get more severe. It IS possible to reverse, however, with hard work. Often, women with PCOS will have a mother or sister with similar symptoms (as PCOS tends to run in families). Interestingly, my sister later found out that she also has PCOS.
When undergoing testing to see if you may have a PCOS diagnosis, your doctor should take a full family history, conduct a physical exam, collect blood to check the levels of androgens, cholesterol, and glucose in the blood, and do a pelvic exam or ultrasound to check the ovaries. Generally, if a woman has two of the three features listed below, there is a good case for a PCOS diagnosis. It just so happened that I had all three!
Let’s get back to the question at hand. Why is it so hard for women with PCOS to lose weight? Aside from the difficulty in getting a diagnosis and possibly being unaware that you have the condition in the ‘lean form’ of PCOS, the cycle of insulin resistance is the biggest factor at play here.
Insulin is a very important hormone that is produced by the beta cells in the pancreas. Besides moving glucose out of the bloodstream, insulin also helps to regulate how fat is used by the body. When the liver can no longer hold any additional stored sugar, insulin tells our fat cells to convert the extra circulating glucose and turn it into more fat.
When IR occurs, the beta cells of the pancreas are encouraged to produce additional insulin to regulate the amount of glucose in the bloodstream. As IR worsens, higher levels insulin are then needed to have the same effect on blood sugar. Additionally, the increased levels of circulating insulin also inhibit the breakdown of fats.
So in essence, insulin tells our bodies to store more fat and then to keep that fat. Pretty much downright refuses to let that fat go…Is it just me or do you wish that you could take your insulin and give it a right punch in the face?! Are you beginning to notice that ‘a punch in the face’ is my go-to move? Darn insulin makes our lives so difficult!
Ironically, weight loss is the key to successfully reversing many of the symptoms caused by PCOS. One study in Human Reproduction emphasizes that weight management in women between the ages of 14 and 31 years seems to be a crucial time window during which the women with PCOS who are destined to develop Type II Diabetes experience a massive weight gain. Therefore, managing weight in adolescence and early adulthood is crucial to preventing Type II Diabetes in women with PCOS.
So how is it possible to reverse the symptoms of PCOS and lose the weight that is stubbornly clinging to your body? Here are a few tips to help you melt away those pounds…
It is essential that women with PCOS exercise with the specific intent of combatting their associated insulin resistance. High Intensity Interval Training (HIIT) workouts are a fantastic way to improve insulin sensitivity and burn calories in the shortest amount of time. HIIT workouts are usually 30 minutes and only need to be performed 3-4x per week (MAXIMUM). HIIT workouts are extremely intense (as the name suggests), but they are also very effective for weight loss – especially in the midsection. HIIT helped me lose my spare tire! Learn more about HIIT workouts and the science behind why they are so effective for PCOS here.
Metformin (Glucophage, Glucophage XR, Glumetza, Fortamet, and Riomet) is an oral anti-diabetic that is often prescribed for women with PCOS. According to author and certified diabetes educator (CDE) Gary Scheiner, ‘Metformin is the most prescribed medicine for type 2 diabetes, and one of the most widely used drugs in the world.’
Metformin works by decreasing the amount of glucose that is produced by the liver (in every human body the liver releases small amount of glucose throughout the day). As a result of the decrease in glucose production/release, blood sugar is also lowered. Metformin also works to lower blood sugar by increasing the body's sensitivity to glucose and by decreasing the amount of glucose that is absorbed from foods that are consumed. Some women taking Metformin may see a decrease in their cholesterol levels as well as weight loss due to the drug’s effect on appetite.
Want a more natural way to increase insulin sensitivity? Try Inositol.
There are two forms of Inositol that are generally used to improve PCOS symptoms: Myo-Inositol and D-chiro-Inositol. Myo- has been well documented to be the superior form with regards to improving insulin resistance, egg quality, and the risk for gestational diabetes in women with PCOS. The best results, however, are seen when both Myo- and D-chiro- are combined in a specific ratio.
Eat to nourish your body, keep stable blood sugar, and fight inflammation.
Due to the IR in women with PCOS, it is important to consume foods that are low on the glycemic index and in glycemic load. This allows blood sugar to stay relatively stable throughout the day and helps to avoid large spikes in blood sugar. A ketogenic diet, one that is high in fat and very low to no carb is often recommended for women with PCOS. Carbs tend to be high on the glycemic index (which has a negative impact), while fats, especially the healthy kind, are great in helping to fight inflammation.
PCOS causes a large amount of inflammation in the body, so any foods that can aid in lowering inflammation are helpful. Cherries, leafy greens, turmeric, and foods high in omega-3 fats (chia seeds, hemp seeds, flax seeds, walnuts, and salmon) are all fantastic to consume to fight inflammation. Lastly, be sure to drink PLENTY of H20!
Ghrelin and leptin responses (hormones that regulate hunger and fullness) can be off in women with PCOS. This means that one may feel hungry when they are not truly hungry. Be sure to drink enough water to fight off phantom hunger! Eat regularly throughout the day to avoid the voracious hunger that can sneak up and cause those awful diet-murdering cravings!
PCOS is a chronic condition. Overcoming its symptoms is a battle that is hard-won but SO worth the effort. After all, there are few things in life that are more important than your health. If you’re wondering whether if I feel amazing, energetic, and spritely everyday while managing my own PCOS…I wish I could tell you that the answer is yes. My fatigue is something that I battle with on a daily basis. My cravings do occasionally haunt me. BUT, I have established a mantra that I repeat to myself each morning, “I eat food for fuel and to give me the energy to sustain my body so that I can do amazing things each and every day. I eat food to nourish my body and be the best possible version of myself.”
I’ve never been much of a mantra person, but this has really helped me stay on track with my nutrition. Use it, tweak it, try it…maybe it will help you too!
Finally, when it comes to exercise…I’ll be honest with you. Some days I finish my HIIT workouts drenched in sweat, feeling like I just want to drag my sorry behind back to bed and sleep for the rest of the day. (Yes, without showering. That’s the depth of it!). Other days, I finish my HIIT workouts feeling like I’m the unstoppable queen of the freaking universe. You will have good days and you will have bad days. So is life. The important thing is that you have more good days than bad days! I can promise you one thing…
I’ve seen both sides of this condition, managed and unmanaged, and there is not one single thing that could convince me (not a delicious dessert, not the feeling after a rough workout, nothing) that a women dealing with PCOS would be better off when the condition is unmanaged. It can be a long, slow process to lose the weight.
Know that there are other women out there working at it too. Join a PCOS community and support your cysters in their health journeys! Do the work and you will see results. I want health and happiness for each and every one of you beautiful ladies! You deserve it and you can have it!
For more information on PCOS, please visit one of the following resources:
Written by Morgan García
Morgan García, creator of PCOS Project, has spent the past 10 years researching the physical, mental, and emotional effects that Polycystic Ovarian Syndrome (PCOS) has on the body. Morgan was diagnosed with PCOS at the age of 15, and has found her passion in helping other women overcome the symptoms associated with the condition. Morgan graduated with a degree in Biology, concentrating in Human Physiology, from Drexel University and has a background working in research and managing medical devices to enable minimally invasive surgical solutions for women with cysts and fibroids. She also works as a health and wellness coach, and specializes in leading women with PCOS to a path of health and happiness.
Visit Morgan at www.pcosproject.com or contact her at firstname.lastname@example.org.
American College of Obstetricians and Gynecologists. (2015). Polycystic ovary syndrome. Retrieved Nov 12, 2017, from http://www.acog.org/Patients/FAQs/Polycystic-Ovary-Syndrome-PCOS
U.S. Department of Health and Human Services, Office on Women's Health. (2014). Polycystic ovary syndrome (PCOS) fact sheet. Retrieved Nov 11, 2017, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html [top]
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Ollila ME, West S, Keinänen-Kiukaanniemi S, et al. Overweight and obese but not normal weight women with PCOS are at increased risk of Type 2 diabetes mellitus-a prospective, population-based cohort study. Hum Reprod. 2017 Feb;32(2):423-431. doi: 10.1093/humrep/dew329. Epub 2016 Dec 28.
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