We tend to think of gaining weight as primarily an issue related to diet and exercise, and for the most part that is true; if you eat more calories than you burn through normal bodily functions and physical activity, you’ll gain weight. Yet there are other factors that are often at work that can affect different people in different ways. Indeed, there are certain diseases and conditions that include weight gain as a symptom or simply make you more likely to gain weight. One such condition is polycystic ovary syndrome (also known as polycystic ovarian syndrome), a disorder that only affects women of reproductive age.
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder of the endocrine system, the part of the body that sends “messages” throughout the body in the form of hormones secreted by various glands. The syndrome is so named because of small cysts that can form on the ovaries. These cysts are small fluid-filled sacs that are actually a sign of PCOS rather than any kind of cause. And even though the disorder is named after the cysts, some women will develop them and some women will not.
PCOS is estimated to affect as many as five million women of reproductive age per year in the United States. Most women discover that they have polycystic ovary syndrome in their 20s and 30s, but it can develop at essentially any age after puberty. The majority of women only find out they have PCOS when they are having trouble getting pregnant and reach out to a doctor. A woman is more likely to develop PCOS if they have a blood relative who also had it at some point.
PCOS can be somewhat difficult to identify or diagnose in large part because the symptoms are often unclear or not present. Some women may have numerous symptoms and some may not have any clear symptoms at all. One of the most common signs is having missing or irregular periods; this typically means having fewer than eight menstruation periods in a given year, though it can vary from person to person. It can also mean having more frequent periods or periods stopping altogether. Below are some additional common symptoms of polycystic ovary syndrome:
Another possible sign of PCOS is infertility. In fact, polycystic ovary syndrome is one of the most common causes of infertility in women. Under normal circumstances, hormones regulated by the endocrine system cause the ovaries to produce the eggs that are then released and available to be fertilized by male sperm. In women with PCOS, however, an imbalance of these hormones can cause disruptions to the cycle and prevent the eggs from being released or developing properly.
The hormonal imbalance that can lead to infertility is also the primary mechanism of all symptoms of PCOS. The underlying cause of this imbalance is not currently known, but genetics appear to be involved in having a higher likelihood of making too much hormone. Androgen, the male hormone responsible for regulating the development of male characteristics, is one of the hormones that are overproduced by the ovaries. High androgen levels can prevent ovulation and therefore disrupt the menstrual cycle as well as cause the formation of acne and the growth of excess body hair.
The other relevant hormone is insulin, a hormone released by the endocrine system that regulates metabolic activity and blood sugar levels. Insulin allows cells in the body to utilize glucose found in the bloodstream for their energy needs. Women with PCOS tend to produce too much insulin, and this can eventually lead to insulin sensitivity and insulin resistance, conditions where the body is no longer able to respond normally to insulin. The body then produces increasingly more insulin in an effort to use the glucose in the bloodstream. This creates a variety of health problems, including even greater androgen production.
Perhaps the most noticeable aspect of insulin resistance is the fact that it leads to weight gain and obesity. And while PCOS can contribute to the development of insulin resistance and subsequent weight gain, it’s usually not the sole cause. In this sense it would be more accurate to say that having PCOS makes it more likely to gain weight when other factors are taken into account. Diet and physical activity levels are also major components of virtually any type of weight gain.
When a person’s regular diet is too high in sugar and other simple carbohydrates, it stimulates the pancreas to produce more and more insulin. As noted above, this increase in insulin can lead to a vicious cycle where more is produced and it becomes less effective, and then more is produced to compensate and it continues to be less effective. Over time, this results in high insulin levels and high blood sugar levels. In response, the body begins to store the excess sugar as fat deposits around the body; for women it tends to be in the thighs and buttocks, and in men it tends to be in the abdomen.
Over time, fat deposits accumulate and will eventually start to negatively affect health. One way doctors measure this is through body mass index (BMI). BMI is a figure that is derived from a comparison of a person’s height and weight. While there are limitations to this tool, it can be helpful in predicting whether a person is obese to the point of having an impact on health. A BMI of 18.5 and under is considered underweight, a BMI of 18.5-24.9 is considered normal weight, a BMI of 25-29.9 is considered overweight, and a BMI of 30 or higher is considered obese.
While PCOS has no specific cure, many of the symptoms are treatable. Birth control pills and anti-androgen medication can sometimes help with improving the regularity of the menstrual cycle as well as excess hair growth and acne. Metformin, a medication typically used to treat type 2 diabetes, has also been used successfully to treat symptoms including infertility. In cases where infertility is still an issue, in vitro fertilization may be necessary.
Some of the treatments for polycystic ovary syndrome may reverse some of the factors that contribute to weight gain, but they likely won’t help you lose weight on their own. Actually losing excess body weight requires being in a calorie deficit, typically through lifestyle changes like reducing caloric intake or increasing physical activity levels. Beyond the aesthetic benefits of weight loss, it can reduce the risk of obesity-related conditions like type 2 diabetes, heart disease, hypertension (high blood pressure), sleep apnea, and stroke.
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