How to Lose Weight with PCOS: Science-Backed Strategies

Polycystic Ovarian Syndrome (PCOS) is a hormone imbalance that’s probably more common than you think. About 1 in 10 women of childbearing age are diagnosed with PCOS. Many find out they have it in their 20s and 30s, when they have trouble getting pregnant. But it’s not just fertility that can be affected. PCOS can lead to changes in your skin, hair growth, and metabolism.

PCOS can also affect your weight. For many people, it leads to weight gain. Learning why PCOS affects weight can help you find ways to support your health and feel your best. We’ll review the link between PCOS and weight and share strategies to help you manage your weight in a way that feels right for you.

Why does PCOS cause weight gain?

PCOS can cause weight gain in a few different ways. One major reason is that it can lead to insulin resistance. That means that your body has a harder time using insulin effectively. Insulin’s job is to move sugar from your blood into your cells for energy. When your body doesn’t use insulin well, your blood sugar levels go up. That extra sugar is then stored as fat, leading to weight gain. About 50% to 90% of women with PCOS will develop insulin resistance at some point. 

There’s also some evidence that people with PCOS might have more food cravings and might take longer to feel full. Researchers think this might be the result of changes in hormones and brain pathways that regulate hunger and fullness. People with PCOS are also more likely to have mood disorders that lead to binge eating. 

Another way that PCOS affects weight is through increased androgen production. Androgens are hormones that everyone has, but they’re often called “male hormones” because they play a big role in male traits like body hair. Higher androgens can lead to more weight gain, especially around your waist. 

How common is weight gain with PCOS?

Despite all the ways that PCOS affects weight, weight gain isn’t inevitable. Researchers have found that somewhere between 40% and 80% of women with PCOS will have excess weight. 

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But some women have symptoms of PCOS like infertility and acne without any weight changes. This is often called “lean PCOS.” It can take longer for women with lean PCOS to be diagnosed because they don’t fit the classic picture. 

Can losing weight help with symptoms of PCOS?

Yes, losing weight can help improve symptoms of PCOS. A large review of studies looked at women with PCOS who were randomly assigned to weight loss interventions with either lifestyle changes or medications. Researchers found that women in both types of weight loss programs had better blood sugar control, better hormone levels, and more regular periods. 

And it doesn’t have to be a large amount of weight loss to make a difference. Even losing 2% to 5% of body weight can be enough to make a difference in symptoms like irregular periods and infertility. 

Your focus doesn’t need to be on a number, though. Some weight loss strategies — like increased movement and a healthy diet — can help with symptoms of PCOS even if your weight doesn’t change. In fact, for people with lean PCOS, weight loss isn’t recommended. Instead, moving more and eating plenty of fruits and vegetables is best. These changes have been shown to improve insulin resistance and androgen levels in people with lean PCOS. 

How to lose weight with PCOS

When you have PCOS, it can feel like a challenge to find a weight that feels best for your body. Here are some tips to help manage your weight and feel more comfortable, no matter what number the scale shows. 

Dietary changes 

When it comes to food choices, there isn’t one single diet that works best for everyone. But these strategies may help you find a comfortable weight: 

• Choose foods with a low glycemic index (GI): Low-GI foods help keep your blood sugar more stable after meals. This is especially important for people with insulin resistance. These foods often include many fruits, vegetables, grains, and dairy products. 

• Eat more fiber: Women with PCOS who eat more fiber have less insulin resistance and less excess weight. Adding fiber-rich foods to your meals can help you feel full after meals, which can also help you lose weight.

• Eat fewer carbs: Eating more protein and fewer carbs — known as the ketogenic diet — has been shown to help lower weight and improve hormone levels in women with PCOS. 

• Aim for unprocessed foods: Ultra-processed foods can cause big spikes in blood sugar and weight gain. Eating plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats — like with the Mediterranean diet — can help lead to a lower weight. 

• Adjust your portions: Eating smaller portions may help you lose weight with PCOS. More frequent, smaller meals can also help keep your blood sugar levels more stable. But avoid overly restrictive diets, which can pave the way for eating disorders. 

Remember that the goal for your dietary approach is to find a way of eating that is sustainable in the long run. Rather than drastic measures, look for ways to eat that feel nourishing and achievable. 

Exercise

Strength training and cardio workouts can both be helpful when you’re trying to lower your weight. But when it comes to PCOS, exercise changes more than just your weight. Exercise can help your body regulate blood sugar and hormones, making it an essential part of managing PCOS.

Experts recommend: 

• 150-300 minutes of moderate-intensity cardio or 75-150 minutes of vigorous-intensity activity per week. 

• Strength training at least 2 days each week. 

It can feel daunting to start a workout plan, especially if you’ve never exercised or if you’re starting again after a long break. Start small, incorporate variety, and consider working out with an exercise buddy. Create clear goals to help you stick with your exercise routine. 

Stress management

Stress can lead to insulin resistance. So, it’s especially important to find ways to manage stress if you have PCOS. Stress may also play a role in gaining weight. One study looked at markers of stress in the saliva of women with PCOS. Researchers found that women with higher markers of stress in their saliva had higher weight and waist size. 

So, reducing your stress can be helpful for your overall health and your weight. Consider incorporating new habits geared towards lowering stress like: 

• Practicing mindfulness

• Yoga

• Deep breathing exercises 

• Spending time in nature 

• Connecting with animals 

Find what makes you feel like you can truly relax. And look for ways to make that a regular part of your lifestyle. 

Supplements

Several supplements show promise for treatment of PCOS and insulin resistance. They may also help you find a comfortable weight. Supplements that may be helpful for PCOS include: 

• Berberine

• Chromium

• Probiotics 

• Myo-inositol and D-chiro inositol 

• Vitamin D

• Omega-3 fatty acids

• Curcumin

• Coenzyme Q10

While supplements can help, they don’t replace a balanced diet. If you’re considering starting supplements, reach out to a healthcare professional you trust to decide which supplements might be best for you. 

If you have PCOS, can you take weight loss medication?

Yes, you can take weight loss medication if you have PCOS. There are many types of weight loss medications, including oral pills and injection medications. 

Metformin is an oral medicine designed for Type 2 diabetes that is often used to help manage symptoms of PCOS. It can also help lower or maintain weight loss. 

Some experts feel that certain GLP-1 agonist drugs — like liraglutide — might be best for PCOS because they help treat insulin resistance as well as weight. But there isn’t enough research to recommend one type of weight loss medication for people with PCOS who have increased weight. 

One thing to keep in mind is that the GLP-1 agonist medications are contraindicated during pregnancy. Many women are diagnosed with PCOS while trying to get pregnant. While weight loss can help women with PCOS get pregnant, GLP-1 agonist drugs aren’t recommended for those actively trying to get pregnant. 

Medications also come with potential side effects. GLP-1s like Ozempic and Wegovy can slow gastric emptying significantly, and cause symptoms like nausea and vomiting. Metformin also may cause GI distress like diarrhea, nausea, gas, and cramping. 

If you have PCOS and are considering medication for weight loss, talk to a healthcare professional about your medical history, weight, and health goals. Together you can come up with a plan that works best for you. 

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Written by:

Katie Horrell, MS, RDN, CPT

Katie Horrell, MS, RDN, CPT, is a passionate dietitian nutritionist and personal trainer with more than 6 years of expertise in telehealth, health coaching, and online education. Specializing in polycystic ovary syndrome (PCOS), insulin resistance, and mindful eating, she guides people through struggles with their eating and exercise habits with empathy and compassion, and an emphasis on a healthy and sustainable relationship with food.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Reviewed by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician in a variety of clinical settings. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

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