PCOS, or polycystic ovary syndrome, is an endocrine condition that some researchers believe may be on the rise. According to the CDC, about six to 12 percent of American women of childbearing age have PCOS.
This condition, which causes cysts to form on the ovaries, can affect everything from endocrine health to gut health to fertility and even skin health. Because PCOS is multifaceted, its symptoms can vary greatly depending on the individual. In fact, women who don’t know they have PCOS are sometimes even misdiagnosed.
A PCOS belly is one of the most commonly experienced symptoms of PCOS, and looks different from other types of weight gain. In this article, we’ll be diving into what PCOS belly is, what causes it, and then share some tips for PCOS-related abdominal weight gain.
What is a PCOS Belly and What Causes It?
Like any other syndrome, PCOS can involve a variety of different symptoms. One of the more common ones is abdominal weight gain, which is often referred to as the “PCOS belly.”
A PCOS belly is the result of PCOS-related weight gain and may be caused by different factors. Weight gain in individuals with PCOS follows a characteristic pattern that involves more abdominal visceral fat gain compared to the rest of the body.
This kind of weight gain in the lower abdomen appears to be associated with inflammation. Research shows that the adipose tissue, or fat, in the abdomen of women with PCOS contains inflammatory molecules. These molecules can increase oxidative stress in the body and may lead to glucose dysfunction as well as insulin resistance.
PCOS belly is also physiologically different from other types of weight gain. Many women will report having an enlarged belly while the rest of their body has remained the same size.
This may be due to excessive weight gain in the abdomen, bloating, or a mix of both. Women with this condition may also find it difficult to lose weight. However, abdominal weight gain is just one potential symptom of PCOS. Here are a few other symptoms to watch out for if you suspect you may have PCOS.
Other Symptoms of PCOS
PCOS is a different experience for every woman, and each person may experience a unique range of symptoms. Along with a little extra belly fat that some women may notice, here are some other common symptoms of PCOS:
- Irregular menses
- Pain during menses
- Excessive hair growth (hirsutism)
- Constipation and/or diarrhea
- Low mood or mood imbalances
- Feelings of anxiety
- Food sensitivities or intolerances
If you are experiencing any of these symptoms for an extended period of time, consider consulting your primary care physician or a medical professional to rule out PCOS.
Things to Consider if You Have a PCOS Belly
Here are a few things to keep in mind if you’re dealing with PCOS-related weight gain.
The Connection Between Hormones and Inflammation
PCOS is also characterized by hormonal imbalances such as:
- Excess androgen levels such as high testosterone, which may be related to the difference in how women with PCOS metabolize estrogen
- Elevated insulin levels
- Insulin resistance
- Low progesterone (which may contribute to irregular menses)
Working to address these imbalances may help reduce inflammation and reduce a PCOS belly. You will want to work with your doctor and nutritionist, as this may involve a mix of different lifestyle changes (and, for some, medications).
Gut Health and Hormones
The gut plays an important role in regulating sex hormones such as estrogen. The gut microbiome works to metabolize such hormones, and gut dysbiosis can contribute to hormone imbalance. It may also contribute to conditions such as PCOS.
Some research has found a link between specific types of dysbiosis conditions such as IBS and PCOS. This suggests that focusing on balancing the gut microbiome may help alleviate some PCOS symptoms.
Here are some tips for healthy gut function from Heather Davis, MS, RDN, LDN, and dietitian at Nutrisense:
1) Focus on Whole Foods
When it comes to a PCOS diet, aim to eat nutrient-dense whole foods to meet your unique macronutrient and micronutrient needs and avoid highly processed foods. If you aren’t sure what your personal needs might be, consider working with a qualified nutrition professional who can help you take a closer look.
2) Address Dietary-Induced Stress
Address additional dietary factors that can lead to physiological stress, such as nutrient imbalances and potential food sensitivities or intolerances. This may include gluten intolerance, dairy allergies, or even sensitivity to high levels of carbohydrates.
3) Get Appropriate Amounts of Exercise
Getting regular exercise or moving your body every day can have a number of positive health benefits. It’s great for weight management or obesity, and can even help reduce your risk for type 2 diabetes and heart disease.
While there may be ways in which exercise can reduce inflammation and improve microbiome composition, it’s important to make sure you’re doing the right amount and type of exercise for your body. Pushing harder and faster than you might be conditioned/fueled for may be counterproductive.
In some cases, physical activity may lead to a 50 percent reduction in intestinal blood flow, a stressor on the gut that can potentially lead to a leaky gut. Consider working with a sports nutrition professional to find the right balance.
4) Limit Alcohol Consumption
Consuming less alcohol may be helpful, as it’s known to affect the GI tract motility, absorption, and permeability. Learn more about the numerous positive effects of a healthy gut, including improved blood sugar levels, here.
Focus on a Nutrient-Dense Diet
As we mentioned, focusing on eating a healthy diet can go a long way if you are dealing with unpleasant symptoms of PCOS such as weight gain. Here are some PCOS friendly nutrient-dense foods that can help support your endocrine health, gut health, and even PCOS-related inflammation.
1) Experiment with Different Macronutrient Ratios
Following a low-carb diet isn’t always necessary for individuals with PCOS, though this type of diet may be beneficial for people with signs of insulin resistance. Dietary sensitivities may vary from person to person, so it’s important to speak to a dietitian or nutritionist about the best type of eating pattern for individualized needs.
Experimenting with different carb and macronutrient ratios to help determine carb sensitivity and glucose tolerance may be beneficial. The amount of carbohydrates a person is able to tolerate can depend upon the level of insulin resistance, but many with PCOS may have a lower carbohydrate tolerance.
Low-carb or ketogenic diets rich in non-starchy veggies, proteins, and fats may be an option for some. It’s important to discuss diet and nutrition choices with a credentialed dietitian or doctor before making significant changes.
A continuous glucose monitor (CGM) is one way to learn more about how the body reacts to certain types of foods to help you make healthier lifestyle choices.
2) Find the Right Caloric Intake for Your Body
Eating too many or too few calories can have negative effects. Feelings of sluggishness and malaise may be worsened by putting large amounts of food into the gut at once. When that food gets broken down, insulin resistance may be further exacerbated by large spikes in blood sugar. High caloric intake may exacerbate some problems related to PCOS.
However, many women with PCOS may try over-restricting calories in an effort to lose weight. Watch out for this trap! Under-eating can also sabotage weight and metabolic health goals. PCOS is also a prevalent cause of infertility, so it’s important for people with PCOS to eat a balanced diet when trying to get pregnant.
3) Consider Reducing Alcohol
Alcohol may have an effect too. Not only do we see the potential for heavier regular consumption of alcohol to impair insulin sensitivity directly, but even moderate consumption of alcohol may lead to higher amounts of estrogen circulating in the body. Alcohol can impact how the body processes estrogen and other hormones.
Alcohol consumption may also increase the risk of certain estrogen-sensitive cancers. Studies show that consuming higher amounts of alcohol can increase the risk of endometrial cancer, as well as breast cancer, and this link may have a strong connection to the changes in how our body processes estrogen.
PCOS symptoms are strongly related to endometrial cancer risk. In fact, women under age 50 with PCOS have a four times higher likelihood of endometrial cancer than women without PCOS.
4) Consider Reducing Caffeine
Due to the hormonal changes happening in PCOS, many may find it difficult to maintain consistent energy levels, and reaching for more caffeine may seem like the obvious solution. But not so fast!
Caffeine may alter the perception of energy levels by altering how the adenosine receptors function, but it won't actually increase cellular energy production (ATP) or provide fuel for actual energy production.
Caffeine may boost energy in the short to medium term, but some studies suggest that more fatigue may result over the long-term for some people, as the body compensates for this initial stimulant effect by increasing sensitivity to adenosine over time, among other mechanisms.
Another area to consider is caffeine’s impact on cortisol. In PCOS, cortisol levels are often persistently elevated. In some studies, we see that both short and long-term caffeine use may elevate cortisol for some people.
This response also seems to be impacted by other medical factors, such as how likely someone is to develop hypertension. Those who may already be borderline hypertensive or with a positive family history appear to have more rapid and prolonged cortisol responses to caffeine. In those with PCOS and/or insulin resistance, the risk of hypertension is higher.
Research is still ongoing, but those with both insulin resistance and hypertension may be more susceptible to the negative effects of caffeine on the HPA axis and cortisol dysregulation.
Get the Right Type and Amount of Exercise In
As we mentioned earlier, more exercise isn’t always better. It’s all about balance and finding what works best for your unique body. Over-training or over-exercising can be just as detrimental to hormonal health as not exercising enough.
The right type and amount of exercise will differ for each person, so it’s important to listen to your body. Not only can appropriate exercise help with PCOS-related weight loss, but it may also support healthy menstrual cycles.
You may want to focus on strength training to help improve body composition and insulin sensitivity, but this may depend on your preferences as well. Here are some other exercises to try with PCOS:
- Flexibility training
- Strength or resistance training
- Mindful movement such as walking, stretching, and rejuvenating yoga
Engage with Your Blood Glucose Levels with Nutrisense
Your blood sugar levels can significantly impact how your body feels and functions. That’s why stable blood glucose levels can be an important factor in supporting overall wellbeing.
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Heather is a Registered and Licensed Dietitian Nutritionist (RDN, LDN), subject matter expert, and technical writer at Nutrisense, with a master's degree in nutrition science from Bastyr University. She has a specialty in neuroendocrinology and has been working in the field of nutrition—including nutrition research, education, medical writing, and clinical integrative and functional nutrition—for over 15 years.