Polycystic ovary syndrome (PCOS) is the most common endocrinological disorder in women of reproductive age with a prevalence of 6-20% (1), with some of the symptoms of PCOS occurring in about 30% of women. The clinical features of PCOS are very different in terms of clinical manifestations and also vary depending on the age of the affected women (from adolescence to the post-menopause) (1).
One of the conditions related to PCOS is weight gain. It is exactly the relation between the PCOS and weight gain that we elaborate on in this article.
What is PCOS?
Polycystic ovary syndrome is an endocrinological disorder in women of reproductive age, characterized primarily by irregularities in the menstrual cycle, infertility, and numerous aesthetic defects such as body and face hair, acne, seborrhea and increased hair loss (1).
There are several ways in which we diagnose PCOS today. According to the 2004 Rotterdam Consensus, the diagnosis of PCOS is based on the existence of two of the following three criteria:
- Oligo – and/or anovulation,
- Clinical and/or biochemical signs of hyperandrogenism,
- Ultrasound findings of polycystic ovaries (1).
Hyperandrogenism and menstrual disorders are the most common problems in adolescent PCOS patients, while elevated levels of androgens, oligomenorrhea or amenorrhea, and in particular infertility, are the most common problems of PCOS women of reproductive age.
Overweight patients (with BMI> 25) are commonly seen among the PCOS population. Weight gain accompanies the polycystic ovary syndrome, with approximately 50% frequency; usually precedes the manifestation of the clinical parameters of this syndrome, suggesting a pathophysiological role in the development of PCOS and associated infertility. In PCOS patients, android obesity and increased amount of visceral fat are dominant. Most of these women (about 80%) also have insulin resistance. Overweight PCOS patients have almost the same rates of cardiovascular disease and type II diabetes as men.
In general, PCOS significantly increases the risk of infertility, dyslipidemia, type II diabetes, sleep apnea, hypertension, cardiovascular disease, a disorder of uterine bleeding, hyperplasia and endometrial cancer, while obesity, as a frequent companion to this syndrome, further contributes to their occurrence (1).
How is weight gain related to PCOS?
Obesity is strongly associated with PCOS, although the reasons for this association are not yet fully understood. At least 30% of the PCOS patients are obese. In some studies, this percentage reaches up to 75%. Obesity in women with polycystic ovary syndrome has not only negative effects on their reproductive capacity but also negative long-lasting health effects. As a result, it is very important to take PCOS and weight gain seriously. Let’s first try to understand the mechanism behind these conditions.
PCOS patients have a higher incidence and severity of insulin resistance and consequent hyperinsulinemia compared with healthy populations of the same age and weight (2). Insulin resistance is independent of obesity itself and has been found in both normal BMI and obese PCOS patients, but it becomes more pronounced with weight gain.
Studies have found a strong association between menstrual cycle disorders and insulin resistance in PCOS. Hyperinsulinemia in itself contributes to the development of anovulation by acting directly on the ovaries that do not show insulin resistance unlike other tissues (liver, muscle, adipose tissue). Elevated insulin levels together with LH and ACTH lead to an increased expression of the P450c17 gene, which controls the activity of the 17-alpha-hydroxylase and the 17/20-lyase enzymes. These enzymes are involved in the production of androstenedione and consequently lead to elevated values of androstenedione, testosterone and dehydroepiandrosterone sulfate (DHEA-S). Elevated insulin levels and hypersecretion of LH lead to increased androgen production in yellow body cells, thus lacking follicle maturation, which ultimately results in anovulatory cycles (2).
The existence of insulin resistance, especially among obese PCOS patients, poses a further risk of developing cardiovascular disease and type II diabetes. The prevalence of type II diabetes in the general population is about 3-4%, with an increase of 10-18% in the elderly, while in PCOS women, this risk is increased by 3-7 times, and is further exacerbated by age and weight gain (2).
Obesity itself is a condition that leads to the imbalance of female sex hormones. The synthesis of sex hormone-binding globulin (SHBG) is reduced due to elevated levels of androgens and insulin, which in circulation leads to an increase in free testosterone. Also, SHBG tends to fall linearly as the adipose tissue amount increases. Reduced plasma SHBG levels in obese PCOS patients lead to exacerbation of hyperandrogenemia, hirsutism, acne, and menstrual disorders relative to normal body weight patients.
The signs of sensitivity to elevated androgens include:
- hirsutism (2),
- oily skin, hair, acne,
- hair loss – android alopecia,
- elevated libido,
Dyslipidemia is a condition that is commonly associated with PCOS. Several studies have found elevated levels of cholesterol, LDL, VLDL, and triglycerides, while the levels of HDL were low. Hyperandrogenemia is considered directly responsible for the increase in triglyceride levels but not in other lipids. Lipid disorder in PCOS is associated with central fat accumulation and hyperinsulinemia because insulin-resistant adipocytes secrete multiple molecules associated with inflammation and IR. These are elevated leptin, resistin, free fatty acids, angiotensin II, PAI-1, TNF-alpha, while adiponectin is reduced. An adipokine imbalance (leptin, resistin, adiponectin) is thought to be involved in the formation of IR.
Blood pressure is elevated in PCOS patients even after BMI correction. Obese patients have elevated systolic but not diastolic blood pressure, while those with oligomenorrhea and hirsutism have elevated values of both systolic and diastolic blood flow. In addition, the risk of cardiovascular disease, especially myocardial infarction, is usually increased in PCOS patients, compared to a healthy population of the same age.
Reproductive disorders caused by obesity in relation to PCOS
The most common cycle disorders (in 90% of cases) are anovulatory cycles that primarily go hand in hand with oligomenorrhea, and less frequently with amenorrhea (20-30%). The regular cycle is rare in patients with PCOS, and it is not always ovulatory. About 40% of women who have regular cycles and hirsutism have anovulation. Anovulation, or the non-repressed long-acting estrogen, is associated with dysfunctional uterine bleeding and menorrhagia.
Oligomenorrhea is considered a risk factor for the development of type II diabetes and this risk is emphasized, although not fully explained. Obese women with PCOS have a reduced ovulatory response to the pulsatile action of the GnRH analogs, and thus a greater need for gonadotropin stimulation during the induced IVF/ICSI cycles. In addition, ovarian stimulation results in fewer aspirated follicles, a higher abortion rate, and fewer successful pregnancies and births.
In general, obesity increases maternal and fetal mortality. There is also an increased risk of pregnancy hypertension, toxemia, gestational diabetes, urinary infections, cesarean section, and more frequent hospitalizations.
Therefore, it is of the utmost importance to control both PCOS and weight gain as these conditions affect one another.
How you can lose weight safely with PCOS?
Most women, at some stage in their lives, are dissatisfied with their body weight and want to lose some weight. 6 in 10 women with polycystic ovaries suffer from increased weight and obesity. Therefore, we can say that there is a strong relation between PCOS and weight gain. Moreover, polycystic ovaries carry many health complications, one of them being insulin resistance, a condition in which cells do not respond to the hormone insulin, which is otherwise responsible for regulating blood glucose levels (3). Insulin resistance results in the accumulation of blood glucose, which results in a further increase in blood insulin levels and creates a vicious cycle.
High levels of insulin increase the production of androgens or male sex hormones. It is believed that elevated levels of androgens are the cause of increased hairiness, acne, irregular periods and weight gain in the abdomen. That is why women with polycystic ovary syndrome tend to have the shape of an apple rather than the more feminine pear shape. Insulin resistance and the resulting weight gain in polycystic ovary syndrome carry numerous health problems, including type 2 diabetes, high cholesterol, and blood pressure and sometimes sleep apnea leading to heart and blood vessel disease. This is why women with polycystic ovary syndrome are even seven times more likely to have a heart attack than healthy women of the same age.
The key is healthy weight loss! Weight loss is one of the first tips given to women with polycystic ovary syndrome. Experts agree that a loss of 5 to 10 percent of body weight is sufficient to significantly reduce illness-related problems and normalize menstruation. However, thanks to the insulin resistance, the task of losing weight can be very difficult and can be the source of frustrations.
However, weight loss must be imperative since it contributes to the normalization of insulin levels and consequently reduces the risk of serious illness. Therefore, adopting certain eating habits and regular physical activity represent the first and foremost steps in the treatment of polycystic ovary syndrome.
As carbohydrates are associated with elevated insulin levels, women with polycystic ovary syndrome are often advised to have a low glycemic index diet and to base their diet on lean meat, fish, whole grains, milk and dairy products, and fruits and vegetables.
Many women interpret these rules in the following way: they completely exclude carbohydrates from their diet. However, such a practice is not advisable because the diet then becomes imbalanced and carries a lot of other health risks. Some authors point out that obese women with polycystic ovary syndrome should provide 40 percent of their energy with carbohydrates, with preference given to foods rich in dietary fiber that provide a long-lasting sense of satiety and have a lower glycemic index.
Women with polycystic ovary syndrome are also advised to practice aerobic activity at least three times a week. It is also wise to introduce weight training that will help build muscle and thus speed up the metabolism.
Diets for women with PCOS
Here are a few efficient diets for patients with PCOS trying to lose weight.
1. Low carbohydrate diet
This is a diet that minimizes the carbohydrate intake, which automatically means that you will need to increase your protein intake. This type of diet will increase the feeling of satiety, you will not be hungry, and you will notice the results very quickly even without accurately counting calories.
Reduced carbohydrate intake is quite effective when it comes to treating insulin resistance and type 2 diabetes, but be sure to talk to your doctor before deciding on this diet.
2. The keto diet
This diet follows a pattern of decreased carbohydrate intake and increased fat intake. After some time, you will experience an increase in the production of ketones, which become the main source of energy instead of carbohydrates. This is especially helpful when it comes to lowering insulin levels and losing weight. Also, this diet leads to an improvement in hormone levels.
What about Low-calorie diets?
Low-calorie diets include diets with an intake of no more than 800 calories during the day. These diets are very effective when it comes to losing weight for women who have polycystic ovary syndrome, but also for those who are simply overweight (4).
However, there is a trap! The biggest problem with diets like this is that their effects are short-term. The weight usually rapidly returns and this can have long-lasting negative effects on your metabolism.
Finally, let’s not forget that, in the treatment of the polycystic ovaries, the goal is not rapid weight loss (often followed by the yo-yo effect) but a long-term change in one’s eating habits, where we lose from half to one kilogram a week, where the onset of the yo-yo effect is very small or unlikely.
Changing your lifestyle is the first and the most important step in the treatment of PCOS, as well as breaking the vicious circle between the PCOS and weight gain. Polycystic ovaries are a problem for many women and require multidisciplinary treatment.
Cinnamon as an effective therapy for PCOS and weight gain?
Scientists have conducted several studies on the consumption of cinnamon and its relation to the PCOS. Results have indicated that cinnamon reduces insulin resistance in women with polycystic syndrome, but the effect on the menstrual cycle has not been examined to date. More studies are needed on this topic.
PCOS and Physical Activity
Physical activity is not only a measure of prevention but also a therapeutic measure in patients with PCOS. Physical activity effects on PCOS include:
- improving insulin sensitivity
- an increase in the frequency of ovulatory cycles
- cholesterol reduction
- advancement of body composition.
Here are some of the recommended training. First of all, aerobic training is highly recommended. Minimum 30 minutes per day, 3 or 4 days a week, including fast track, jogging, cycling, and swimming, leads to an improvement of the patient’s health condition.
Best results are achieved when combining aerobic activity and strength training.
The effectiveness of stretching exercises should not be overlooked, so some Pilates programs and yoga are especially suitable for PCOS patients.
When it comes to strength training, the accent is on the major group of muscles. The strength training should be practiced a minimum of 2 days a week. Loads should be such that it is possible to do 10 to 15 repetitions.
PCOS therapy is complex, but what each person can do is change their diet, introduce more cereals, fruits and vegetables, proteins, healthy fats, with controlled carbohydrate and trans-fat intake, which is the basis of a healthy lifestyle together with regular hydration of the body as well as dosed, moderate and individually programmed physical activity.
If you suffer from the polycystic ovary syndrome, follow these rules to make it easier to cope both with PCOS and weight gain:
- eat foods rich in dietary fiber such as fruits, vegetables, and whole grains,
- avoid processed foods and junk food, as they badly affect blood sugar and insulin levels
- limit red meat intake
- increase the intake of fish to at least once a week to provide enough omega-3 fatty acids
- increase your folic acid and folate intake. Folic acid and folates are forms of Vitamin B that are of great importance when it comes to reducing the production of a component in the blood called homocysteine. A high level of this component increases the risk of heart attack and stroke, and women who have polycystic ovary syndrome usually also have an elevated component. Foods containing folates and folic acid include spinach, asparagus, green salad, broccoli, avocado, oranges, mango, etc.
- control the blood sugar levels by eating 4 to 6 smaller meals a day
- avoid alcohol
- consult your doctor about medication therapy.
Polycystic ovary syndrome is certainly one of the most common hormonal disorders that many women around the world suffer from. This syndrome goes hand in hand with severe consequences, such as infertility, irregular periods, increased hair growth on face and body, cysts on one or both ovaries, sleep apnea, insulin resistance, and metabolic problems, etc.
Although this problem is quite widespread, there is very little information on how it can be treated naturally. In this article, we talked about natural ways in which you can regulate your PCOS and weight gain and thus diminish the consequences of this condition.
(1) Witchel SF, Oberfield SE, Peña AS. Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls. J Endocr Soc. 2019 Jun 14;3(8):1545-1573. doi: 10.1210/js.2019-00078. PMID: 31384717; PMCID: PMC6676075. Found online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676075/
(2) El Hayek S, Bitar L, Hamdar LH, Mirza FG, Daoud G. Poly Cystic Ovarian Syndrome: An Updated Overview. Front Physiol. 2016 Apr 5;7:124. doi: 10.3389/fphys.2016.00124. PMID: 27092084; PMCID: PMC4820451. Found online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820451/
(3) Kataoka J, Tassone EC, Misso M, Joham AE, Stener-Victorin E, Teede H, Moran LJ. Weight Management Interventions in Women with and without PCOS: A Systematic Review. Nutrients. 2017 Sep 8;9(9):996. doi: 10.3390/nu9090996. PMID: 28885578; PMCID: PMC5622756. Found online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622756/
(4) Nikokavoura EA, Johnston KL, Broom J, Wrieden WL, Rolland C. Weight loss for women with and without polycystic ovary syndrome following a very low-calorie diet in a community-based setting with trained facilitators for 12 weeks. Diabetes Metab Syndr Obes. 2015 Oct 14;8:495-503. doi: 10.2147/DMSO.S85134. PMID: 26508882; PMCID: PMC4610794. Found online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610794/