Why women with PCOS have a harder time losing weight

Hormones have many important functions in the body such as regulating our growth and development and driving our metabolism. When our hormones are functioning properly, they send us hunger cues and satiety signals, keeping us from overeating and helping us maintain desirable body weight. However, there are certain conditions that change our hormonal status. This disruption changes the way our bodies oxidize (or break down) and/or utilize sources of fuel, like fats and carbs, in turn modifying our body composition. PCOS, or polycystic ovary syndrome, is one of these conditions and it is characterized as an imbalance in female hormones. 

PCOS is becoming more and more prevalent these days, affecting about 5-10% of U.S. women of childbearing age. This increase in the number of PCOS cases is associated with a rise in the exposure of endocrine-disrupting chemicals, or chemicals that interfere with hormonal systems, and use of cosmetics with endocrine-disrupting ingredients. The major culprits behind the increasing rates of PCOS include chemicals from pesticides, vehicle exhausts, industrial pollutants, and household cleaning agents, but also personal care products like perfume, sunscreen, deodorant, hair dye. These hormone-disrupting chemicals in consumer care products appear in the form of fragrance, emulsifier, preservative, and color. The chemical products contain phthalates, parabens, glutaraldehyde, metals (like nickel sulfate, cobalt chloride), benzophenones to name a few. Theses hormone-disrupting chemicals can also be found in packaged and canned foods if the packaging contains bisphenol A (BPA) that leaches into the food. These chemicals and ingredients can interfere with the enzyme aromatase, which is responsible for converting androgen into estrogen. 

Unfortunately, many people are unaware of the disruptive nature of the products they’re using. A woman could in fact develop PCOS from these environmental stressors. PCOS manifests as an imbalance in the female hormones – elevated levels of estrogen and anti-Mullerian hormone (AMH), and low levels of progesterone – and often times as very high levels of androgen. The imbalance in female hormones that is typically seen in PCOS results in immature ovarian follicles and sometimes leads to the formation of cysts, or water-filled sacs, in the ovaries. These cysts produce androgen. Androgen is present in both males and females, but because this hormone plays a role in the development of male traits and male reproductive activity, it is present in higher levels in males. In women, androgens are normally produced in small quantities in the ovaries, adrenal glands, and fat cells. As the ovarian cysts in PCOS patients produce more and more androgens, the woman may develop insulin resistance, weight gain, and abdominal fat. Unlike the ovary of a normal-cycling woman, the PCOS ovary is therefore resistant to the normal action of insulin – in response to this resistance, the body produces even more insulin. The high levels of circulating insulin further trigger the ovaries to produce even more androgens, creating a vicious cycle between high levels of insulin and of androgens. 

Both androgens and insulin play a role in the accumulation of fat, especially since insulin in the main fat storage hormone in the body. Fat, or adipose tissue, generates high levels of the enzyme aromatase, which is involved in glucose homeostasis, and resists the hormones leptin (which quenches hunger) and insulin. All the events in this cycle can also be magnified by obesity, since fat cells increase levels of androgen. 

While this cycle makes it seem impossible to lose weight, there are some things that can be done. First, you can normalize insulin levels and improve your cell’s insulin sensitivity by avoiding or minimizing your intake of sugar from sodas, fruit juices or other sugar-sweetened beverages, and sugar from snacks like cookies, cakes, pastries. Physical activity is another good way to improve insulin sensitivity and to lose weight, but it also works to lose abdominal fat, reducing androgen level. A few studies have found that 3 days of moderate intensity exercise per week can help women with PCOS lose weight. Exercise and weight loss also improve your muscle’s ability to respond to insulin and take in sugar. 

You can also focus on a diet rich in whole foods like fruits and vegetables, whole-grain foods like whole wheat bread and pasta and brown rice, and legumes like beans, peas, and lentils. Lean meats and low-fat or fat-free milk, cheese, or yogurt can also help to improve your body’s ability to use insulin and to normalize hormone levels.