When PCOS Affects Weight and Fertility, Lifestyle Changes Can Help

Dr. Christopher McGowan
February 21, 2023

If a woman is experiencing problems with her hormones, polycystic ovary syndrome (PCOS) could be the diagnosis. With PCOS, the ovaries produce an abnormal amount of androgens, sex hormones that are more prevalent in men and typically found in only small amounts in women. Additionally, many small cysts, or fluid-filled sacs, can develop on a woman’s ovaries (although some women with PCOS do not have cysts). As a result, a woman’s menstrual periods can be irregular. For instance, this could mean very few periods, or periods that abnormally last for several days in a row.

Symptoms of PCOS

Not only does PCOS often cause discomfort and frustration with menstrual periods, but it can also cause problems with a woman’s ability to get pregnant. According to the Centers for Disease Control and Prevention, about six to 12 percent of women of child-bearing age have PCOS, and it is one of the most common causes of female infertility. Higher levels of androgens can lead to several other symptoms for women with PCOS, such as:

  • mood swings
  • increased body hair in unwanted or more masculine areas
  • weight gain in more masculine places (i.e. around the stomach)
  • acne/oily skin
  • thinning hair in male-characterized areas (i.e. top of the head)
  • sleep apnea

PCOS & Insulin Resistance

While the cause of PCOS is unclear, it is clear to medical professionals that most women with PCOS experience some level of insulin resistance, a condition that is linked to weight gain and problems with losing weight because it forces the body to respond differently to calories. It can be recognized physically with symptoms such as dark patches on the skin or skin tags. It can also create an endless cycle of discouragement—while losing weight can help to alleviate PCOS symptoms, women with PCOS may also have a harder time losing weight. This can create a seemingly endless cycle of frustration and discouragement for these women, who may already be struggling with other challenging symptoms related to this diagnosis.

How and why does insulin resistance affect weight? We know that insulin facilitates the body’s transformation of glucose into energy, yet insulin resistance inhibits this process. When the body’s cells resist insulin signals, the pancreas produces even more insulin, which leads to the negative impairment of appetite-regulating hormones, increased hunger, more fat storage, and blood sugar spikes that cause extra sugar to be stored as fat. Sleep apnea is also associated with insulin resistance and weight gain. 

Many True You Patients Struggle with PCOS

True You Weight Loss sees many female patients who already have a PCOS diagnosis, and also some who have not yet been diagnosed. These patients tend to be frustrated with their inability to lose weight using conventional methods, combined with struggling over other symptoms of the condition, such as infertility. 

True You nurses and health coaches are diligent about monitoring for PCOS by having in-depth conversations with patients about their symptoms and menstrual cycles. While it’s uncommon for our team to “officially” diagnose PCOS, we often identify the signs and refer patients back to their OB/GYN, primary care provider or endocrinologist for additional testing (which could include blood tests, ultrasound, etc.).

“At True You, we have helped many PCOS patients with their weight loss goals. As a result, we have seen many patients overcome infertility and become pregnant, if that is their ultimate hope,” says Emily Weaver, BSN, RN, AGPCNP, nurse practitioner at True You. “PCOS patients should know they can absolutely have a healthy pregnancy after weight loss surgery. In fact, reaching a healthy body weight has a positive impact on getting pregnant.”

Weight Loss Strategies for PCOS Patients

While there is no cure for PCOS, it can be effectively and successfully managed with a good weight loss plan, lifestyle changes, and professional support. According to Kathleen Walton, MS, RD, LDN, registered dietitian with True You, optimizing nutrition is a critical strategy PCOS patients can use to help with weight loss.

“Macronutrient distribution, eating foods with a lower glycemic index, and limiting processed foods are all ways to use nutrition to combat PCOS,” said Kathleen. “We encourage patients to fill half of your plate with lower glycemic foods to balance blood sugar and avoid spikes and crashes that can lead to weight gain. Stress management is also key to weight loss success with PCOS.”

Here are some other weight loss strategies Kathleen recommends for patients with PCOS:

  • follow an individualized macronutrient distribution plan of quality proteins and fats
  • eat carbohydrates with a low glycemic index
  • pair carbohydrates with proteins and healthy fats (to lower glycemic index)
  • limit processed foods that are high in saturated fat, sugar and sodium; these hyperpalatable foods will cause cravings for more saturated fat, sugar and sodium
  • limit red meat, and instead choose other proteins such as fatty fish
  • eat a high-fiber diet
  • reduce inflammation by eating whole (natural, unprocessed) foods
  • avoid “undereating,” as limiting calories can affect metabolism and lead to weight gain
  • manage stress levels by creating a work/life balance
  • engage in lower stress exercise and activities, such as yoga, weight lifting, breathing techniques and meditation

The best types of foods for a healthy PCOS diet include quality protein such as chicken breast, turkey, eggs, yogurt, cottage cheese; fatty fish, such as salmon; nuts like walnuts and almonds; leafy greens, such as kale and spinach; dried beans and lentils; dark red fruits, such as red grapes and blueberries; healthful fats, such as olive oil and avocados; and vegetables, such as broccoli and cauliflower. Meanwhile, foods to avoid that may cause PCOS flare-ups include refined carbohydrates, such as pastries and white bread; fried foods and fast-food meals; sugary beverages; processed meats, such as hot dogs and deli meats; dairy products; solid fats, such as margarine; and excess red meat, such as steak and hamburger.

“As with limiting certain foods, limiting certain types of exercise is important for patients with PCOS as well,” adds Emily. “High-intensity cardio, for example, can put the body under high stress that forces it to release more cortisol and androgens. For a woman with PCOS, this will exacerbate symptoms. Therefore, it’s important to engage in low-impact exercise activities, like yoga and weight training, so that the body can utilize insulin without a stress response.”

Individualized Weight Loss Treatment Plans Are Key

At True You, we believe that an individualized treatment plan for weight loss is important to helping our PCOS patients feel heard, understood and motivated to keep going on their weight loss journeys. We work hard to find the solutions that are appropriate for each unique patient, as well as the correct combination of nutritional strategies that will be effective. Weight loss plans will depend on age, severity of PCOS symptoms, and overall health. Care is also based upon whether or not a patient hopes to become pregnant in the future.

“At True You, our PCOS patients each receive a weight loss plan that is best for their own, individual needs,” adds Kathleen. “To determine the right mix of macronutrients, we look at things like how a patient is reacting to certain foods, their hunger and energy levels throughout the day, and if their bodies are experiencing any transformations. We listen closely to what our patients are telling us about their physical health, and we always make adjustments until we start seeing those desired results.”

Does Medication Help?

Weight loss plans for patients with PCOS may also include certain medications to help boost progress. Metformin is sometimes prescribed for PCOS patients to help the body better utilize insulin and promote a healthy weight. Medications for insulin sensitivity and androgen regulation can also be effective, depending on the patient.

“These medications are not life-changing, but they can help support our efforts,” explains Emily. “Overall, we want patients to know that we are highly experienced in working with PCOS and individualizing care. Women with PCOS can live normal and productive lives, as well as overcome barriers to fertility, if that is the focus. We are here to support them in making lifestyle changes and finding strategies to minimize symptoms and achieve weight loss success.”

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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