What does a “PCOS belly” look like?

PCOS is a complex endocrine disorder that affects many women in the UK of reproductive age. Although the exact cause remains unknown, most experts agree the condition is driven by insulin resistance and high levels of androgens, sometimes referred to as ‘male’ hormones.
 
PCOS can lead to a range of challenging symptoms, including acne, excessive facial and body hair, and menstrual irregularities. Unfortunately, these physical effects are often associated with poorer mental health outcomes, with many women experiencing anxiety, depression, and low self-esteem.
 
PCOS can also cause weight gain, especially around the abdomen area, resulting in what some have colloquially called ‘PCOS belly’.
 
It’s worth mentioning this piece isn’t designed to demonise weight gain. Toxic narratives around body shapes can, in fact, lead to further weight gain, disordered eating, and feelings of shame. As always, you have the final say on how you look. Living in a smaller or heavier body is your choice.
 
However, if the so-called ‘PCOS belly’ bothers you, simple dietary and lifestyle tweaks can make the weight loss journey a bit easier. 

 

What is ‘PCOS belly’?

Women with PCOS often have higher fat deposits in their midsection, irrespective of body mass index (BMI) (1). This means that even leaner individuals can have a ‘PCOS belly’.
 

PCOS belly shape

Some women with PCOS report having a larger abdominal region while the rest of their body remains the same size (2). The lower stomach may appear large and bloated, or small and round. It can also feel firm to the touch. 
 
Generally speaking, ‘PCOS belly’ is the build-up of fat around the middle, resulting in what is known as an ‘apple-shaped’ body.
 

PCOS bloating

Bloating can also contribute to the ‘PCOS belly’. Women with PCOS often have low progesterone and high androgens, ‘male’ hormones, resulting in water retention and bloating. Gut imbalances, which are common in PCOS, can lead to bloating, too (3).
 
In some cases, ‘PCOS bloating’ can be caused by a combination of hormone-related water retention and gut dysbiosis.
 

What causes PCOS belly fat?

 
As with most PCOS symptoms, higher-than-normal androgen levels, insulin resistance, and chronic inflammation are often behind ‘PCOS belly’.
 
Insulin resistance increases adipose tissue (body fat), which tends to accumulate in the abdomen before growing in other areas (4).
 
To complicate matters further, insulin resistance and weight gain exist in a vicious cycle. Insulin resistance stimulates fat storage in the body, especially around the midsection, and having more body fat exacerbates insulin resistance, perpetuating the negative feedback loop.  
 
Reducing insulin resistance, therefore, should be a top priority if you want to manage PCOS and its related symptoms, like ‘PCOS belly’.
 
You can read more about PCOS weight gain here.
 

How to treat PCOS belly

 
Unfortunately, you can’t spot-treat the so-called ‘PCOS belly’. It’s a symptom of PCOS, so addressing the condition as a whole – in a holistic, 360-degree way – is the best course of action.
 

Diet

 
There’s no one-size-fits-all way diet for managing PCOS and its symptoms, like weight gain. But several simple changes can help.  
 

Focus on wholefoods

 
As a rule of thumb, any healthy, balanced PCOS diet should consist of nutrient-dense, whole foods – foods in their ‘whole’ form, like strawberries or broccoli. This will lay a good foundation for optimal health and weight loss. Avoiding ultra-processed and refined foods will help, too.  
 

Choose low-GI foods

 
High insulin levels can exacerbate PCOS symptoms, like weight gain. For this reason, following a low-GI diet is one of the best ways to manage PCOS.
 
The body digests low-GI foods more slowly, meaning they don’t lead to spikes in blood sugar. These foods also keep you fuller for longer, which can help prevent overeating.
 
A 2021 review reported that low-GI diets could lower insulin resistance and belly fat in people with PCOS more effectively than high-GI diets (5).

Here are some of the low-GI foods you may wish to build your meals around:
 

• Vegetables

• Whole fruit instead of juices

• Complex carbohydrates, like quinoa, buckwheat, and whole-wheat pasta

• Legumes, such as lentils, peas, and chickpeas

• Nuts and seeds

• Lean proteins, including oily fish and organic chicken breast

 
Just the same, you may want to avoid the following high-GI foods:
 

• White bread, rice and pasta

• Breakfast cereals

• Dried fruits

• Cakes and sweet treats

• Potatoes and chips

• Sweetened dairy products, like yoghurts

 

Think anti-inflammatory foods

 
Chronic inflammation and PCOS often go hand in hand. Many women with PCOS have high inflammatory markers, which may contribute to weight gain (6). Minimising inflammation, then, is another important consideration.
 
Eating a Mediterranean-style diet – packed with whole foods, leafy green vegetables, fruits, extra virgin olive oil, oily fish, like salmon, and whole grains – is the easiest way to reduce inflammation and manage PCOS.
 
Avoiding sugary foods, gluten, and dairy products will also help lower inflammation.
 

Support gut health

 
Aside from supporting mood, skin, and immune function, gut health plays a role in weight maintenance, making it an important consideration for women with PCOS (7).
 
There are many ways to support your gut health. Increasingly, experts recommend eating 30 different plant foods every week (8). These foods are rich in polyphenols and fibre, which feed your gut microbes.
 
Upping fibre also increases feelings of satiety, further supporting healthy weight management. One study reported higher fibre intake was associated with less total body fat and lower insulin resistance in those with PCOS (9).
 
In addition to fibre, eating more fermented foods, like natural yoghurt, kefir, kombucha, pickles, sauerkraut, miso, tempeh, and kimchi is an easy win for your gut health. Fermented foods are thought to increase the microbial diversity of your gut bacteria, which is a marker of good gut health (10).
 
Besides this, you may wish to add live cultures and natural soluble fibre derived from chicory root to your diet to help the gut work optimally.
 

Reduce alcohol

 
Excessive alcohol consumption directly impacts insulin sensitivity, which can worsen PCOS symptoms, like weight gain and ‘PCOS belly’, so it’s worth exercising caution around drinking where possible (11).
 
Alcoholic beverages also contain ‘empty calories’; they’re calorie-dense but offer little in the way of nutrition. A pint of cider can have as many calories as a sugared doughnut! Consuming these seemingly ‘invisible’ calories can lead to weight gain over time, especially around the midsection.
 
Try to keep your alcohol consumption within 14 units a week. And consider having several drink-free days weekly, too.
 
You can learn more about supporting weight loss with PCOS here.
 

Lifestyle

 
Diet aside, simple tweaks to your lifestyle can help you manage PCOS, weight gain, and other symptoms, like ‘PCOS belly’.
 

Exercise moderately

 
Regular exercise can improve insulin sensitivity, regulate ovulation, support mood, improve cholesterol, and, of course, aid weight loss, making it one of the best ways to manage PCOS symptoms.
 
There’s a temptation to overdo it when you want to lose weight. But more exercise doesn’t necessarily mean more weight loss for women with PCOS. Overtraining can, in fact, put your body under increased stress, which could inadvertently worsen PCOS symptoms (12).
 
With this in mind, focus on moving moderately on most days of the week. Guidelines suggest 150 minutes of moderate-intensity exercise weekly. Strength training, HIIT workouts, and mind-body exercises, like yoga and Pilates, are great activities to build into your routine.
 

Get enough sleep

 
Good sleep is the cornerstone of good health. Poor sleep, conversely, is linked to hormone dysregulation and insulin resistance, risks already associated with PCOS and weight gain (13).
 
Inadequate rest can also disrupt your hunger and fullness hormones, as well as make you less active during the day, which can undermine your attempts to lose weight.  
 
Make a conscious effort to get at least 7-9 hours of uninterrupted sleep every night. Ensuring your bedroom is a quiet, cool, and dark place, avoiding caffeine after midday, and following a wind-down routine before bed are some of the changes you can implement to support your sleep hygiene.
 
You can learn more about improving your sleep here.
 

Manage stress

 
Whether it’s a strongly worded email from your boss, standstill traffic, or the 24-hour news cycle, stress is an inevitable part of our modern-day life.
 
Stress can affect the body in many different ways. In the context of PCOS, however, stress can contribute to weight gain. It increases levels of cortisol, the stress hormone, in turn, triggering insulin resistance and making weight more likely.
 
PCOS, of course, can be a stressor in itself. Due to the distressing nature of symptoms – including ‘PCOS belly’ in some cases – many women experience mental health challenges, like anxiety and low self-esteem, which can cause a negative feedback loop.  
 
While you can’t avoid stress altogether, having an arsenal of tools can help buffer against the downstream effects of stress, bring your body in alignment, and support your emotional health.
 
Yoga, meditation, journaling, and connecting with the people you love are some of the ways you can try to manage daily stress. More mindfulness and less stress have even been associated with lower abdominal fat, which is particularly helpful for women struggling with ‘PCOS belly’ (14).
 

Supplements

 
Besides dietary and lifestyle changes, the addition of supplements could help manage PCOS and its related symptoms, like ‘PCOS belly’.
 

Myo-inositol

 
Myo-inositol is one of the best supplements for women with PCOS. This vitamin-like compound is thought to regulate insulin, which may, in turn, support healthy weight management.
 
You can read more about using myo-inositol for PCOS here.
 

Chromium

 
An important trace mineral, chromium plays a role in glucose stabilisation, making it great for women with PCOS struggling with cravings and a higher BMI.
 

Vitamin D3

 
Vitamin D3 is known to improve hormonal regulation, inflammation, and oxidative stress (15). Given its far-reaching impact on health, low vitamin D3 levels could be a barrier to weight loss for women with PCOS.
 

Find out more

 
Managing PCOS is a long-term commitment; consistency and patience with your efforts will pay dividends for your health and improve symptoms.
 
Again, it’s worth stressing that you – and you alone – get to decide how your body looks. But if the so-called ‘PCOS belly’ bothers you, then there are plenty of ways to help manage it.
 
You can find similar guidance on our dedicated health hub. Alternatively, please get in touch with our team of expert Nutrition Advisors, who are on hand to provide free, confidential advice.
 

References:

1. Zhu S. et al., Imaging-based body fat distribution in polycystic ovary syndrome: A systematic review and meta-analysis. Frontiers in Endocrinology. 2021;12.

2. Carmina E, Bucchieri S, Esposito A, Del Puente A, Mansueto P, Orio F, Di Fede G, Rini G., Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance. J Clin Endocrinol Metab. 92(7):2500-5.

3. Sun Y, Gao S, Ye C, Zhao W., Gut microbiota dysbiosis in polycystic ovary syndrome: Mechanisms of progression and clinical applications. Front Cell Infect Microbiol. 13:1142041.

4. Carmina E, Bucchieri S, Esposito A, Del Puente A, Mansueto P, Orio F, Di Fede G, Rini G., Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance. J Clin Endocrinol Metab. 92(7):2500-5.

5. Kazemi M, Hadi A, Pierson RA, Lujan ME, Zello GA, Chilibeck PD., Effects of Dietary Glycemic Index and Glycemic Load on Cardiometabolic and Reproductive Profiles in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Adv Nutr. 12(1):161-178.

6. Popovic, M., G. Sartorius, and M. Christ-Crain. (2019) Chronic low-grade inflammation in polycystic ovary syndrome: is there a (patho)-physiological role for interleukin-1? Seminars in Immunopathology, 41(4): 447-459.

7. Insenser M, Murri M, Del Campo R, Martínez-García MÁ, Fernández-Durán E, Escobar-Morreale HF. (2018) Gut Microbiota and the Polycystic Ovary Syndrome: Influence of Sex, Sex Hormones, and Obesity. J Clin Endocrinol Metab. 103(7): 2552-2562.

8. Jones P. (2023) Eating 30 plants per week: How to do it and why. Eating 30 Plants per Week: How To Do It and Why. Available at: https://joinzoe.com/learn/30-plants-per-week

9. Cunha NBD, Ribeiro CT, Silva CM, et al. (2019) Dietary intake, body composition and metabolic parameters in women with polycystic ovary syndrome. Clin Nutr. 38(5):2342-2348.

10. Marco ML, Sanders ME, Gänzle M, et al. (2017) The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on fermented foods. Nat Rev Gastroenterol Hepatol. 18(3):196-208.

11. Lindtner C, Scherer T, Zielinski E, et al. (2013) Binge drinking induces whole-body insulin resistance by impairing hypothalamic insulin action. Sci Transl Med. 5(170):170ra14.

12. Kreher JB, Schwartz JB, et al. (2012) Overtraining syndrome: a practical guide. Sports Health. 4(2):128-138.

13. Bahman M, Hajimehdipoor H, Afrakhteh M, et al. (2018) The Importance of Sleep Hygiene in Polycystic Ovary Syndrome from the View of Iranian Traditional Medicine and Modern Medicine. Int J Prev Med. 9:87.

14. Daubenmier J, Kristeller J, Hecht FM, et al. (2011) Mindfulness Intervention for Stress Eating to Reduce Cortisol and Abdominal Fat among Overweight and Obese Women: An Exploratory Randomized Controlled Study. J Obes. 651936.

15. Zhao JF, Li BX, Zhang Q, et al. (2021) Vitamin D improves levels of hormonal, oxidative stress and inflammatory parameters in polycystic ovary syndrome: a meta-analysis study. Ann Palliat Med. 10(1):169-183.

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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