Polycystic ovarian syndrome (PCOS) refers to multiple fluid-filled cysts along the outer edge of the ovaries. Polycystic Ovary Syndrome (PCOS) is an endocrine disorder affecting women of reproductive age. According to the PCOS Awareness Association, up to 20% of women suffer from PCOS, which makes it one of the most common disorders related to a hormonal imbalance among women1.
PCOS is characterized by a hormonal disturbance that can cause many symptoms, including cardiovascular problems, diabetes, endometrial cancer, obesity, and depression.
PCOS and Weight Gain
In polycystic ovarian syndrome, ovaries produce androgens (male hormones) in higher amounts. Over-production of androgens interferes with the maturation and ovulation (release of the egg), which leads to the formation of multiple small cysts at the corner ovary2.
Androgens have a prime role in eliciting male-like characters. Weight gain, hairy face, and irregular periods are common with PCOS. Weight gain is more prominent around the abdomen because male hormones cause a male-like body shape (bulky abdomen) in women. Overproduction of estrogen and testosterone also play their part in gaining extra weight3.
Why is Weight Loss Important in PCOS?
Losing weight can have significant benefits for women with PCOS. For example, it helps improve insulin resistance, leading to better blood sugar management and reduced risk of developing diabetes.
In addition, losing weight can improve hormonal imbalances, which can help lessen the symptoms such as excess hair growth, acne, and irregular periods. Moreover, losing weight can improve fertility in women with PCOS, making it easier to conceive4.
Causes And Risk Factors Of PCOS:
Polycystic ovarian syndrome is idiopathic with no exact cause; however, the following risk factors may lead to PCOS5.
- Genetics: PCOS tends to run in families, so if your parents or grandparents suffered from it, there are higher chances that you will inherit it.
- Inflammation: lowgrade inflammation in the long term may lead to PCOS. White blood cells produce certain substances to fight infection, which may cause ovaries to produce androgens in higher amounts.
- Transgender men are more susceptible.
- Insulin resistance: occurs when body cells do not respond to insulin and levels of insulin increase in circulation.
- Obesity: overweight women are prone to because of higher circulating insulin levels.
- Other risk factors include stress, a sedentary lifestyle, and exposure to environmental toxins. However, women may develop PCOS without any prior known risk factors.
Role Of Hormonal Imbalance In PCOS:
Weight gain is inevitable with PCOS. More than 80% of women with PCOS are obese or overweight. Women with PCOS are obese because their body is less sensitive to a hormone called insulin, which converts glucose and starch into energy, referred to as insulin resistance. Glucose and insulin build up in the bloodstream, which leads to obesity6.
The hormonal imbalance makes it difficult to lose weight. Elevated estrogen levels store fat, while high testosterone levels cause visceral fat accumulation.
Higher insulin levels in the body trigger androgen (male hormones) production. Abdominal weight gain is a characteristic feature of PCOS because androgen causes weight gain in the abdomen. So, a woman with PCOS will have apple shape body instead of a typical pear shape.
Symptoms of PCOS
Many women may experience the symptoms during their first period, while others may be aware when they gain weight and experience other symptoms. More than 70 women don’t even know they have polycystic ovarian syndrome7. The following symptoms are common with PCOS:
Irregular periods:
The absence of ovulation prevents the uterus lining from shedding every month on expected days. Hence, there might be the absence of a decrease in periods over the year. Women can experience less than 8 periods or even none at all8.
Heavy bleeding:
Since the uterine lining does not shed regularly and continues to build, when the period onsets, you can experience more heavy bleeding than usual.
Hirsutism:
Women suffering from PCOS experience excessive hair growth on their faces, belly, and chest. Hair growth results from elevated androgen levels in circulation.
Male Pattern Baldness:
Women with PCOS may experience hair loss from the scalp, and hair patterns may become thinner.
Acne:
Androgens lead to the overproduction of oil, making skin oilier than usual, and skin may break out from the face, chest, and back.
Darkened skin:
Dark patches of skin may appear at the neck, chest, breast, and groin regions. Generalized dark patches in women and other symptoms may indicate PCOS.
Recurrent headache:
Hormonal imbalance often leads to headache in women, which doesn’t go away easily. One feels heavy-headed most of the time.
Treatment of PCOS:
Certain medications can help decrease the symptoms and lose weight with PCOS.
Metformin:
Metformin was originally used as a diabetes drug that alters cell energy metabolism. Metformin has a glucose-lowering effect by inhibiting hepatic gluconeogenesis. It helps use insulin more efficiently and reduces testosterone production. Research shows that metformin helps lose weight in obese women with PCOS9.
Semaglutide:
Semaglutide is also an antidiabetic drug having proven efficacy in weight loss induction in patients with PCOS. It is a GLP-1 receptor agonist drug that stimulates insulin release, hence lowering circulation glucose levels. Semaglutide had improvements in menstrual cycle regularity, insulin resistance, and quality of life. Moreover, Semaglutide increases the gastric emptying time and promotes satiety, resulting in decreased food intake10.
Other medicines which increase metabolism can be used in combination with antidiabetic drugs.
Lifestyle Changes:
Besides medication, a healthy lifestyle can help decrease weight loss with PCOS.
- Manage your diet: Eat high-fiber and low-sugar diets. Remember to include fresh vegetables, fruits, and whole grains in your serving.
- Avoid overeating at once; instead, divide the meal into small portions. This maintains normal blood sugar levels.
- Plan a regular 30-minute exercise daily or at least thrice a week.
- Avoid processed foods and added sugars, which may raise blood sugar levels.
- Eat healthy fats, for example, avocado, coconut oil, olive oil, and nut butter.
- Manage optimum sleep and avoid stress as it may exacerbate inflammation.
- Consider supplements like inositol and creatine to boost insulin function.
References:
1. Deswal R, Narwal V, Dang A, Pundir CS. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. J Hum Reprod Sci. 2020;13(4):261. doi:10.4103/JHRS.JHRS_95_18
2. Ye W, Xie T, Song Y, Zhou L. The role of androgen and its related signals in PCOS. J Cell Mol Med. 2021;25(4):1825. doi:10.1111/JCMM.16205
3. Dumesic DA, Akopians AL, Madrigal VK, et al. Hyperandrogenism accompanies increased intra-abdominal fat storage in normal-weight polycystic ovary syndrome women. J Clin Endocrinol Metab. 2016;101(11):4178-4188. doi:10.1210/JC.2016-2586/SUPPL_FILE/JC-16-2586.PDF
4. Silvestris E, de Pergola G, Rosania R, Loverro G. Obesity as the disruptor of female fertility. Reprod Biol Endocrinol. 2018;16(1). doi:10.1186/S12958-018-0336-Z
5. Rosenfield RL, Ehrmann DA. The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocr Rev. 2016;37(5):467. doi:10.1210/ER.2015-1104
6. Wondmkun YT. Obesity, Insulin Resistance, and Type 2 Diabetes: Associations and Therapeutic Implications. Diabetes, Metab Syndr Obes Targets Ther. 2020;13:3611. doi:10.2147/DMSO.S275898
7. March WA, Moore VM, Willson KJ, Phillips DIW, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample was assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25(2):544-551. doi:10.1093/HUMREP/DEP399
8. Polycystic ovary syndrome | Office on Women’s Health. Accessed March 10, 2023. https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
9. Guan Y, Wang D, Bu H, Zhao T, Wang H. The Effect of Metformin on Polycystic Ovary Syndrome in Overweight Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Endocrinol. 2020;2020. doi:10.1155/2020/5150684
10. Jensterle M, Herman R, Janež A. Therapeutic Potential of Glucagon-like Peptide-1 Agonists in Polycystic Ovary Syndrome: From Current Clinical Evidence to Future Perspectives. Biomedicines. 2022;10(8). doi:10.3390/BIOMEDICINES10081989
