How to Lose Weight With PCOS

Weight gain or difficulty losing weight is a common symptom of polycystic ovarian syndrome (PCOS). Because PCOS has a complex metabolic and reproductive hormone imbalance associated with it, the question of how to lose weight with PCOS is more complicated than the standard “eat less and exercise more” many of us hear.

Conversations about weight are complex. In some ways, it feels like we are at the precipice of a significant change in attitudes and beliefs about weight. On one hand, we are bombarded with news about weight loss drugs, and on the other hand, body acceptance and the influence of diet culture are being challenged.

In my clinical experience as a doctor, the most successful weight loss strategies recognize the multifaceted nature of body size and consider the connection between physical and emotional well-being. When I discuss weight, I look at it from the perspective of how to metabolically optimize the system—and the strategies in this article can be employed on bodies of any size to help on the weight loss journey.

Some research suggests that losing 5 to 10 percent of your body weight can improve some of the reproductive, psychological, and metabolic symptoms associated with PCOS. The reality is that weight gain can be challenging to navigate for people with PCOS. Weight doesn't cause PCOS; it's a symptom of the condition. But higher body fat can make it harder to manage other symptoms. 

In this comprehensive guide, I'll share the connection between PCOS and body weight and provide actionable tips for how to lose weight with PCOS.

Introduction to PCOS and Weight Loss

Before we talk strategy, it's helpful to understand why weight, specifically body composition, is a concern for PCOS.

First, it's essential to recognize that not everyone with a larger body is automatically metabolically at risk for conditions like type 2 diabetes or heart disease. What's happening below the surface is more important than any number on the scale.

Research shows that it’s possible we all have our own unique threshold for visceral fat (the fat that surrounds our organs such as our liver and pancreas). Some people may appear lean but have a lower threshold for storing fat. So despite appearing lean, they can have higher risk for insulin resistance and markers of poor metabolic function like high triglycerides and LDL for example.

Conversely, some people who appear heavier on the outside, might have a higher threshold and while it is easy to assume these people will automatically have issues with insulin resistance, they may have a lower risk.

Patients with PCOS are at an increased risk for things like infertility, blood sugar dysregulation, high blood pressure, and other cardiovascular diseases. This is why healthy weight management should be a strategy employed in treating PCOS.

Some research suggests that even small amounts of weight loss can improve ovulatory function (regular ovulation and periods) and blood sugar levels.

At the same time, studies on how to lose weight with PCOS aren't very robust. For example, a study examining women with PCOS found that although more weight loss led to improved ovulation and reduced signs of hyperandrogenism, almost 65 percent of the participants dropped out. This is a considerable number, reflecting just how challenging it is to conduct a study like this.

When trying to lose weight, the message is often about eating less and moving more, so if you aren't seeing a change, you must be doing something wrong, right? Incorrect. It's not that simple, and that message is damaging when there is so much more to the story. Understanding why this doesn't work for PCOS can empower you to make lasting positive changes.

Understanding PCOS

PCOS symptoms like acne, hair loss fertility issues, irregular periods, abnormal hair growth in unwanted places, weight gain, and risk of diabetes are all related to hormone imbalance and metabolic profiles. In many ways, PCOS is as much of a metabolic health condition as a hormone condition. We care about PCOS and fat storage because of the metabolic problems linked to PCOS and weight, like heart disease, insulin resistance, and metabolic syndrome.

Currently, guidelines for a PCOS diagnosis mean someone must have at least two of the following:

• Hyperandrogenism — higher levels of hormones that lead to abnormal hair growth, hair loss, oily skin, and acne
• Ovulatory dysfunction
• Cysts on the ovaries or elevated anti-mullerian hormone (AMH) levels

Because of this, if someone has irregular menstrual cycles and high androgens, ultrasounds and AMH aren't needed for a diagnosis.

One of the key elements here is the elevated androgens. I'll dive into this deeper below, but androgens are hormones typically considered “male” because they are involved in the development of male sex organs and secondary sexual characteristics. 

But women have them too, although they are not used in the same way as they are in a male body. When androgens are too high, they cause problems, like oily skin, acne, excess hair growth on the chin, chest, and abdomen (hirsutism).

How PCOS Impacts Weight Loss Efforts

PCOS can make weight loss difficult for several reasons, one of which being excess insulin production and the relationship between androgens and insulin.

It's a complex vicious cycle where testosterone is linked to insulin resistance. At the same time, the effects of insulin can increase testosterone production in the ovaries.

Insulin is a hormone that regulates blood sugar by moving glucose (blood sugar) out of the blood and into your cells. When cells aren't as responsive to insulin, blood glucose levels remain high, and the pancreas releases more and more insulin. High insulin levels are associated with inflammation, metabolic syndrome, and, yes—even modest weight loss.

When insulin levels increase, as is the case when your cells lose insulin sensitivity and insulin resistance occurs, it promotes fat storage and increased hunger. Both of these factors lead to weight gain.

Expert consensus is that weight loss goals are often an important step in the treatment of some cases of PCOS, especially those with insulin resistance. Still, it's also well-recognized that achieving this weight loss is not simply a matter of how much you eat, but what you eat, how you exercise, and what your current hormone imbalances are.

The Link Between PCOS and Obesity

PCOS and obesity are closely linked. Women with PCOS have a higher prevalence of obesity than the general population, possibly because excess fat tissue produces more hormones that can cause problems like insulin resistance, hyperandrogenism, and chronic inflammation, but also because of other cellular differences in the body.

The Role Metabolic Issues Play in Weight Gain and PCOS

Insulin plays a significant role in menstrual cycle irregularities in PCOS, as higher insulin can stimulate the ovaries to produce more testosterone while lowering the production of sex hormone-binding globulin (SHBG). SHBG binds to androgens, so low levels can contribute to high testosterone in the blood.

Even with more research on PCOS, there still isn't a great understanding of all the metabolic complexities involved. Of course, diet and movement are essential to any weight loss journey, but other factors may contribute.

For example, some research suggests that women with PCOS may have cellular differences in hormones and proteins that regulate appetite and impact metabolic rate, but much more research is needed.

Blood sugar also impacts many other aspects of metabolic health, like sleep, hunger, energy levels, and cravings. High blood sugar may also affect appetite and mood. All of these collectively influence weight and metabolism.

The Emotional Impact of PCOS and Weight Gain

Women with PCOS are much more likely to experience depression, anxiety, and eating disorders, and some of this is likely due to the way PCOS and weight gain can impact self-image. Feeling shame or lack of control about your body significantly affects quality of life, confidence, and self-esteem.

Plus, many women just don't feel they've received the right support from their healthcare team, especially for mental health, and are brushed off and told to eat less, even when they've been bouncing on and off deprivation diets for years.

PCOS and Weight Loss Stigma

Weight loss stigma is a reality for so many people living in larger bodies, and for people with PCOS, it's such an issue that the most recent 2023 PCOS treatment guidelines address the impact. Including making the following statements:

“Many women with PCOS experience weight stigma in healthcare and other settings and the negative biopsychosocial impacts of this should be recognised.”

“Healthcare professionals should be aware of their weight biases and the impact this has on their professional practice and on women with PCOS.”

Weight stigma means someone experiences assumptions, discrimination, or prejudice due to weight or size. This can come from family, friends, healthcare providers, employers, strangers, media, and society as a whole. It's an added layer of stress for many people struggling to manage PCOS's physical and emotional symptoms and can increase the risk of anxiety, depression, eating disorders, and body image issues.

In addition, it can lead to bias by the provider that hinders a PCOS patient receiving adequate care.

Unfortunately, due to lack of education on this issue, it can take time to find a provider who can best support you.

Remember, you have a right to seek out healthcare providers who will work with you in an affirming, non-stigmatizing way and help you manage your PCOS from all angles.

Dietary Changes to Support Weight Loss With PCOS

With all of the above in mind, it's time to switch to tools to empower you to make positive changes. My clinical approach is to promote metabolic health, optimize hormones, and help patients build a nutrition and lifestyle plan that will lend itself to finding a healthy weight for the individual. 

Diet and lifestyle changes are now considered first-line treatment for PCOS. The problem is that most physicians and clinical providers aren't adequately training in nutrition and the research is lacking. In fact, research on PCOS altogether is limited. This is where combining the research we do have, along with clinical expertise is necessary to address the individual and help them reach their goals.

And what we know to be true is that certain diet strategies do promote weight loss with PCOS while addressing the underlying metabolic health concerns—and none of them are about extreme reduction of calorie intake or jumping into a fad diet.

Importance of a Healthy Diet for PCOS Patients

There's no single diet pattern that everyone with PCOS should follow, but there are big-picture principles—think anti-inflammatory foods and food that supports healthy blood sugar levels.

What does this mean? A diet for PCOS should be relatively low in processed or refined carbohydrates, prioritize lean proteins and healthy fats, and include plenty of high-fiber foods and brightly colored produce. Eating consistently can also help reduce blood sugar issues and for most people, spacing out meals and snacks about three to four hours apart is ideal. Here's additional info if you're curious about intermittent fasting.

Fiber

Fiber intake is a critical component to healthy weight loss in women as research has not only shown it has favorable effects on visceral adiposity (fat stored around organs), it also improves gut microbiome health by maintaining healthy bacteria, which is critical in optimizing hormones. Fiber can also help reduce the risk of insulin resistance in women. Aim for 25 grams of fiber per day through fermented foods, sweet potatoes, avocado, raspberries, chia seeds, flax seeds. In fact, incorporating flax seeds as part of seed cycling has not only shown benefit in women with PCOS, but it also helps increase fiber intake. A high fiber diet can help with risk factors like diabetes that accompany polycystic ovary syndrome.

Sugar

While 25 grams is the aim for fiber, 25 grams is the limit on sugar intake. While it has somehow become controversial to counsel people to limit sugar intake, the science is clear that excess sugar intake is associated with the development of diabetes, increased inflammation, and may be a factor in chronic disease. That doesn't mean you can never eat sugar. What it means is that avoiding over consuming sugar can have a major positive impact on your health.

Protein

Strength training, which we'll discuss shortly, should be part of any PCOS weight loss routine. If you're strength training regularly, then dietary protein requirements will be higher. Your specific protein needs may vary, but in general, at least 1 gram of protein per kilogram of body weight is ideal as a minimum intake. While monitoring the grams of protein you eat a day can sound daunting, it has been shown to be helpful in enabling people to understand how much protein is adequate for their daily needs.

Protein also has the benefit of keeping you full longer, buffering against blood sugar spikes, and providing you with necessary fuel to keep your hormones happy and healthy.

I've included even more details and specifics on the best diet for PCOS in this article.

By eating a well balanced diet that doesn't spike blood sugar, you'll release less insulin, which can help reduce androgen levels. These foods also help reduce the risk of heart disease and type 2 diabetes, so it's a win-win for metabolic health and weight management. Plus, all of this can help reduce food cravings!

Foods to Consume

• Nuts
• Seeds
• Fish
• Poultry
• Beef, lamb
• Pork
• Eggs
• Beans
• Lentils
• Vegetables
• Fruit
• Whole grains
• Olive oil, avocado oil, coconut oil, and other healthy fats
• Greek Yogurt (avoid fruit on the bottom or added sugar)

Foods to Avoid

• Soda and other sugar-sweetened beverages
• Refined carbohydrates like white bread or other white flour products
• Processed meats and high fat red meats
• Fried foods
• High-sugar snacks (cookies, candy bars)
• Refined sugars
• Trans fats

Sample Meal Plan for Weight Loss or Control with PCOS

Below is an example of a one-day meal plan. Since everyone's caloric needs vary (and yours can even change depending on activity level or if you're sick), you'll need to tailor the serving sizes to your needs.

If you are trying to lose weight, The Androgen Excess and PCOS Society recommends reducing your current calorie intake by 500-1,000 calories per day. Of course, this depends on your current intake.If you're looking for simple recipes to help you balance PCOS hormones? Grab the free hormone-balancing meal plan and recipe guide filled with healthy foods.

Breakfast	Spinach and Mushroom Omelette: 2 whole eggs or 3 egg whites (you can adjust based on your dietary preferences) Handful of spinach leaves Sliced mushrooms Diced onions Cooked in olive oil or coconut oil 1 small serving of plain Greek yogurt: Top with a few berries (e.g., blueberries, raspberries) for added antioxidants A sprinkle of ground flaxseeds or chia seeds for fiber and healthy fats
Lunch	Grilled Chicken Salad: Grilled chicken breast, slicedMixed salad greens (spinach, arugula, lettuce) Cucumber slices, cherry tomatoes, and bell pepper strips Olive oil and balsamic vinegar as dressing 1 small serving of quinoa or brown rice
Dinner	Baked Salmon: Salmon filet baked with a drizzle of olive oil and herbs Steamed broccoli or asparagus on the side Cauliflower Rice: Sautéed cauliflower rice with garlic and onion for a low-carb alternative to regular rice
Snacks	Carrot and Celery Sticks with Hummus OR ¼ cup nuts with a piece of fruit

Physical Activity for Weight Loss with PCOS

Many women with PCOS feel they don't get enough guidance regarding exercise and physical activity. Like diet and nutrition, movement can be so beneficial for PCOS and weight loss, and there's no single way for everyone to exercise as it depends on your body and needs. But there are general guidelines that are helpful for most bodies.

The Importance of Exercise

Exercise helps with PCOS in several ways:

• Improves menstrual cycle regularity and regular ovulation
• Supports insulin sensitivity so your cells take in more sugar from the blood
• Increases lean muscle to support metabolic rate
• Helps with mood and sleep
• Increases motivation and energy levels
• Improves metabolic factors and lowers the risk of developing metabolic syndrome
• Improves ovarian function and fertility
• Improves ovarian hormones—estrogen, progesterone, and testosterone
• Enhances sexual function

Best Types of Exercise for Polycystic Ovary Syndrome Patients

Studies have attempted to investigate if one type of exercise is more beneficial for people with PCOS, but the results are inconclusive. In general, all movement can help, but a combination of gentle cardio, strength training, and mobility will provide the best results.

In one review study it was found that whether the exercise intervention was 6 weeks or 16 weeks, the benefits on ovarian function and menstrual cycle hormones was measurable. This means that even a short duration is going to be beneficial to your hormone health.

When it comes to the best types of exercise for PCOS patients, what has been shown to be beneficial is 30 minutes of daily exercise at a submaximal heart rate level, which is in the aerobic threshold where you burn fat. 

In some cases, high-intensity exercise isn't recommended because it increases the stress hormone cortisol. Cortisol may negatively influence blood sugar and adrenal health (and may even temporarily increase testosterone), so monitoring your body's response to activity is important. If you find that you are not recovered three days following activity or that you are completely winded for the duration of your workout, you're probably pushing too hard.

Moderate-intensity workouts such as walking, running, swimming, biking, and yoga can all positively affect PCOS symptoms.

Strength Training

Weight lifting, using resistance bands, pilates, and other forms of strength training can help improve insulin sensitivity. It can also improve cardiometabolic health and improve body composition in women. In addition, strength training supports bone health, mood, and can increase the amount of calories you burn when just resting.

Body weight exercises, where you use your own body mass as resistance, can be an effective way to train when getting started, while traveling, or when you find yourself without equipment.

Supplements to Support Weight Loss with PCOS

Supplements tailored to your needs can be essential for weight loss with PCOS in some cases. While no single supplement will be the magic wand, specific herbs, botanicals, and nutrients can be incredibly helpful in addressing improving insulin sensitivity, calming the nervous system, supporting restful sleep, supporting healthy ovarian function, building muscle mass, and more.

Benefits of Supplements for PCOS

Some of the benefits of supplements for PCOS include:

• Blood sugar support
• Hormone balance, supporting regular ovulation and decreasing androgens
• Anti-inflammatory effects
• Metabolic support
• Nervous system support

Recommended Supplements and Their Effects

You can find a detailed article about my top supplements for PCOS here, but some of my go-to's include:

Inositol:

Inositol helps to regulate hormones, reduce insulin resistance, and improve metabolic health to reduce symptoms such as acne and hirsutism and support fertility. Studies have shown that myo-inositol, along with D-chiro inositol, can improve insulin levels (in conjunction with blood glucose), reduce androgens, and positively impact weight loss.

Myoinositol Plus by Dr. Brighten was developed with the ideal balance of myo-inositol and D-chiro-inositol, plus a blend of scientifically backed vitamins, minerals, and herbs to support PCOS.

Berberine:

In one study, participants who took 300 mg of berberine daily experienced a reduction in their waist circumference and BMI after 3 months of treatment. Berberine is an herb that has been shown to elicit benefits on blood sugar similar to Metformin.

Magnesium:

Magnesium is essential for hormone balance, supports relaxation, and may even support weight loss for people with PCOS. Studies have shown magnesium supplementation to result in weight loss and a reduction in waist circumference in subgroups who are insulin resistant, obese, and women.

Magnesium Plus by Dr. Brighten contains bioavailable forms of magnesium that won't upset your stomach.

L-Carnitine:

L-carnitine has been shown to be beneficial in improving metabolic profiles, like reducing LDL, and lowering BMI. Together, this can help reduce cardiovascular risk in PCOS patients.

Chaste tree berry (Vitex):

This herb has been used for centuries to support hormone balance and reduce symptoms such as menstrual irregularity, acne, and hirsutism.

Balance Women's Hormone Support by Dr. Brighten contains Vitex, B vitamins, antioxidants, and other hormone-supporting herbs.

Ashwagandha:

This adaptogenic herb is known for its calming effects on the nervous system to reduce stress hormones and improve sleep quality. Some studies have shown it to be beneficial for weight loss in those with chronic stress.

Adrenal Support by Dr. Brighten contains ashwagandha plus a blend of adaptogenic herbs and nutrients to calm your nervous system and promote restful sleep.

Medications for Managing PCOS and Supporting Weight Loss

While the focus of primary PCOS treatment options should be on lifestyle and nutrition interventions first, there is a place for medications in some cases. However, while medications can be a helpful tool for weight loss and even an effective obesity treatment, they don't replace lifestyle and nutrition interventions. Instead, they should be part of a comprehensive weight loss plan that includes what we've discussed in this article.

Current Medications Available for PCOS

Medications for managing PCOS and supporting weight loss usually focus on blood sugar, lowering androgens, and targeting weight loss.

The most common include:

• Birth control pills
• Metformin
• Spironolactone

My advice is to always always always discuss all the pros and cons of medications before starting so you understand the impact on your body, short and long-term.

Medications Specifically Aiding in Weight Loss

Medications like Ozempic are gaining popularity in PCOS weight loss management. Ozempic and other GLP-1 receptor agonists have been shown to significantly reduce body weight and may help with insulin resistance, inflammation, and lipid (fat) metabolism.

Before starting these medications for PCOS, there are pros, cons, and side effects (and I've written an article all about it here), so I recommend discussing whether it's a good fit for you with your doctor before deciding.

The Role of Stress Management and Sleep in Weight Loss

Both sleep and stress contribute to healthy weight through their influence on circadian rhythms, hormones, and hunger. They can also influence blood sugar, inflammation, and mood. Including strategies for stress resistance and better sleep should not be overlooked when supporting weight loss with PCOS.

Effects of Stress on PCOS and Weight

Research suggests that stress-related factors positively affect body composition alterations in individuals with PCOS. High-stress levels can worsen PCOS symptoms, mainly due to the impact of cortisol on androgens and blood sugar.

Stress can also affect hormone balance, leading to metabolism disruptions and increased cravings for highly processed, nutrient void foods. The relationship between stress and PCOS is complex, with stress exacerbating PCOS symptoms and, in turn, the symptoms of PCOS causing additional stress. Strategies like relaxation techniques, exercise, and professional support (like a therapist) can help with stress and mental health support.

Quality Sleep for Hormonal Balance and Weight Management

Getting enough quality sleep is crucial for weight loss, especially with PCOS. Research has shown poor sleep quality is associated with an increased risk of obesity and insulin resistance. Women with PCOS are also more likely to have sleep apnea, contributing to fatigue, difficulty losing weight, and cardiometabolic health risks.

Lack of sleep can disrupt the balance of hormones that regulate appetite and metabolism, leading to increased cravings, insulin resistance, and inflammation, further hindering weight loss efforts.

Prioritizing sleep hygiene (regular bedtime schedule, cool room, addressing any issues with noise), calming supplements (you can read more details about sleep supplements here), and stress management can all address sleep issues. Investing in a pair of blue light blocking glasses to help raise your melatonin in the evening can also help. 

Conclusion: Living Healthy with PCOS

Living healthy with PCOS means feeling good in your body and nourishing yourself from the inside out. A targeted, multifaceted approach that includes diet and lifestyle changes, appropriate nutritional supplements, and sometimes medications can help you manage your symptoms and achieve a healthy weight.

Tips for Maintaining Long-term Weight Loss

Remember that the path to any weight loss is never linear. Slow, incremental changes are critical for long-term success. Here are some tips to help you stay on track and maintain long-term weight loss:

• Find an accountability partner or join a support group.
• Track your progress and celebrate the small wins.
• Give your body a chance to rest and recover.
• Be mindful of emotional eating and practice healthy coping strategies.
• Prioritize sleep, relaxation, and self-care.
• Remain committed to your goals even when progress seems slow.

Final Thoughts on Weight Management and PCOS

Managing PCOS and weight is not a one-size-fits-all situation. Like each of us is unique, the path to achieving and maintaining a healthy weight should also be personalized. What works for one person may not necessarily work for another—success means finding what makes you feel good and fuels your body appropriately.

If it all seems a bit overwhelming, don't hesitate to reach out for professional support. Nutritionists, dietitians, and healthcare providers can offer tailored advice and guidance.