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Does PCOS cause stubborn belly fat?

Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age. One of the most bothersome symptoms of PCOS is stubborn belly fat that is difficult to lose with diet and exercise alone. In this article, we’ll explore the link between PCOS and belly fat, and provide tips for losing stubborn fat with PCOS.

What is PCOS?

PCOS is a condition characterized by hormone imbalances that can cause irregular or absent menstrual periods, infertility, excess hair growth, acne, and weight gain. The exact cause of PCOS is unknown, but it often runs in families. Some key features of PCOS include:

  • Irregular or skipped periods: Women with PCOS often have irregular menstrual cycles caused by lack of ovulation.
  • Excess androgen levels: Women with PCOS tend to have higher than normal levels of androgens like testosterone. This can lead to symptoms like excess facial and body hair growth, acne, and male-pattern baldness.
  • Polycystic ovaries: Polycystic means “many cysts.” Women with PCOS often have enlarged ovaries containing small collections of fluid called follicles.
  • Metabolic issues: Up to 80% of women with PCOS are overweight or obese. PCOS is also associated with increased insulin resistance, which can raise the risk for type 2 diabetes.

PCOS is usually diagnosed with a combination of medical history, physical exam, blood tests, and ultrasound imaging. There’s no cure for PCOS, but symptoms can be managed with lifestyle changes and medications. Losing weight is one of the most effective ways to manage PCOS.

What causes belly fat in PCOS?

Women with PCOS tend to carry extra weight in their belly region compared to women without PCOS. There are several reasons why PCOS promotes abdominal fat storage:

Hormone imbalances

The excess androgens and altered estrogen levels in PCOS promote abdominal fat deposition. Belly fat contains more androgen receptors compared to fat in other areas. Higher androgen levels cause visceral fat cells to multiply and expand in size.

Insulin resistance

At least 50% of women with PCOS have some degree of insulin resistance. Insulin is a hormone that controls blood sugar levels. In insulin resistance, cells fail to respond normally to insulin. The body has to produce more insulin to keep blood sugar in check. Excess insulin can increase hunger signals and promote fat storage around the belly.


Women with PCOS have higher levels of inflammatory markers like CRP and IL-6. Inflammation is linked to both insulin resistance and abdominal obesity. Belly fat is metabolically active and releases inflammatory compounds that maintain this vicious cycle.

Altered appetite regulation

Research shows that women with PCOS have impaired regulation of appetite hormones like leptin and ghrelin. This can promote increased hunger and calorie intake, driving abdominal fat accumulation.

Is it really that hard to lose belly fat with PCOS?

For most women, belly fat is the most stubborn area to lose. But having PCOS can make it even more challenging for several reasons:

  • Slower metabolism: Women with PCOS tend to burn fewer calories at rest due to impaired insulin sensitivity and more belly fat. A slower metabolism makes weight loss harder.
  • Chronic inflammation: The pro-inflammatory state of PCOS leads to greater insulin resistance over time. This makes continued fat loss more difficult.
  • Hormone fluctuations: Shifts in reproductive hormones like estrogen across the menstrual cycle can alter metabolism and fluid retention.
  • Stress: Coping with PCOS symptoms like infertility, excess hair growth, and menstrual irregularity can be stressful. Stress releases cortisol, which is linked to increased belly fat.

While stubborn belly fat is extremely common with PCOS, it’s not impossible to lose. A multifaceted approach is needed to overcome metabolic and hormonal obstacles.

Tips for losing belly fat with PCOS

Here are some effective strategies to combat stubborn abdominal fat with PCOS:

Follow a PCOS-friendly diet

Certain diets help balance blood sugar, reduce inflammation, and regulate appetite in women with PCOS:

  • Low glycemic index diet: Focus on foods that minimize spikes in blood sugar and insulin, like non-starchy vegetables, lean protein, nuts, seeds, and legumes.
  • Anti-inflammatory diet: Limit processed foods and saturated fats. Eat plenty of omega-3 rich foods like fatty fish, walnuts, and chia seeds.
  • High fiber diet: Aim for 25-30 grams of fiber per day from foods like fruits, vegetables, whole grains, and beans.

Increase exercise

Exercise is extremely beneficial for promoting belly fat loss in PCOS by:

  • Reducing insulin resistance and inflammation
  • Correcting hormone imbalances
  • Preventing loss of lean muscle mass during weight loss

Aim for 150 minutes per week of moderate activity like brisk walking or gentle cycling. Add in 2-3 strength training sessions to maintain muscle.

Take targeted supplements

Certain supplements may also aid belly fat loss in PCOS:

  • Inositol: This B vitamin helps improve insulin sensitivity and metabolic function.
  • Berberine: This compound reduces insulin resistance and may help normalize testosterone levels.
  • Omega-3s: EPA and DHA omega-3 fats have powerful anti-inflammatory effects.

Always consult your doctor before taking supplements with medications.

Manage stress

Finding healthy ways to manage stress is key. Activities like meditation, yoga, journaling, or talking with friends can lower cortisol. Getting adequate sleep and light exercise also curb daily stress.

Consider medications

If lifestyle measures aren’t sufficient, certain medications may be helpful. Insulin-sensitizing drugs like metformin and inositol are commonly used. Anti-androgens like spironolactone can also minimize PCOS belly fat.

Are there any medical treatments to remove belly fat?

For extremely stubborn belly fat, the following medical procedures may be options to consider after trying natural methods:

Prescription weight loss medications

If you have a BMI over 30, weight loss medications like Phentermine or Qsymia may be prescribed alongside diet and exercise. These drugs can help suppress appetite, reduce fat absorption, and increase metabolism. However, they may have side effects.

Gastric band surgery

Gastric banding is a type of weight loss surgery that uses an adjustable band to constrict the size of the stomach. This limits how much you can eat, leading to 20-30% weight loss. It may help reduce abdominal fat, but does not target this area specifically.

Tummy tuck surgery

A tummy tuck or abdominoplasty removes excess fat and skin from the belly. However, this procedure does not reduce deep belly fat called visceral fat. Weight can be regained if lifestyle habits are not improved.


This non-invasive procedure freezes belly fat through controlled cooling. Each session can reduce belly fat by about 20%. Multiple rounds give the best results. The fat cells are eliminated from the body over several months after treatment.

However, medications and procedures should not replace lifestyle treatments for losing stubborn belly fat. Comprehensive diet, exercise, and stress relief help give long-lasting results.


PCOS is a major risk factor for increased belly fat. Imbalanced reproductive hormones, chronic inflammation, impaired insulin sensitivity, and altered appetite regulation all drive abdominal weight gain. While stubborn belly fat is very common with PCOS, it is still possible to lose weight in this area through targeted lifestyle interventions like:

  • Following a PCOS-friendly, low glycemic diet
  • Increasing exercise levels
  • Taking supplements like inositol, berberine, and omega-3s
  • Using stress management techniques

For modest amounts of belly fat, these natural strategies often give great results over time. In severe cases, medications or procedures like CoolSculpting may also be considered alongside lifestyle therapy to help eliminate stubborn fat. With persistence and consistency using the right multipronged approach, most women with PCOS can successfully reduce abdominal obesity and related health risks.