Hormonal imbalances and insulin resistance can cause weight to accumulate around your midsection

Living with polycystic ovary syndrome (PCOS) comes with challenges. The acne. The stray hairs. The periods that are as reliable as public Wi-Fi in a rural coffee shop.

And then there’s the belly fat — often called “PCOS belly.” It’s that stubborn weight around your midsection that doesn’t seem to budge, no matter what you try.

It’s frustrating. And it’s not just about how your clothes fit — it’s also about your health.

We talked with Ob/Gyn Yolanda Thigpen, MD, about why PCOS can lead to belly weight and what to do about it.

What is a PCOS belly?

PCOS belly refers to weight gain around your midsection. It’s a common concern for many women with PCOS.

“Having PCOS can lead to what we call an ‘apple shape,’ where you carry excess weight around your belly even when the rest of your body is lean,” Dr. Thigpen shares.

There are two main reasons why it happens:

  1. Hormonal imbalances: High insulin levels lead to high levels of male hormones, called androgens — a hallmark of living with PCOS. They can cause your body to shift where it stores fat, often sending it straight to your belly instead of your hips or thighs.
  2. Insulin resistance: Oftentimes, having PCOS affects your body’s ability to use insulin properly. That can lead to belly fat and a higher risk of prediabetes and diabetes.

What does PCOS belly look like?

“A PCOS belly is typically a round midsection that’s firm, not soft or fluffy,” Dr. Thigpen describes. “This is due to carrying more fat around the internal organs (visceral fat).”

You can still have a healthy body mass index (BMI) and have a PCOS belly, like if your arms, thighs and hips have a very low body fat percentage. But a PCOS belly means your waist circumference and waist-to-hip ratio (WHR) are higher than is typically considered healthy.

A firm, round abdomen typical of PCOS belly can be a sign of visceral fat. And that’s why it’s worth addressing.

“Visceral fat lives far below the skin,” Dr. Thigpen explains. “High levels of visceral fat surround your organs and can further contribute to insulin resistance and put added strain on your heart.” 

How to get rid of PCOS belly

Let’s not sugar-coat it. Losing a PCOS belly can be tough. PCOS changes your metabolism and your body’s fat-storage system, making it that much harder to lose weight.

But with careful attention to things like diet, exercise and stress management, it can be done. What’s more, the steps you take to care for yourself can make your body work its best. So, even if the results aren’t immediately noticeable to your waistline, your efforts are still 100% worth it.

Dr. Thigpen suggests these best practices for addressing PCOS belly.

  • Diet: A low glycemic diet can reduce inflammation and help your body use insulin more effectively. Not sure where to start? The Mediterranean diet is focused on whole foods and limited processed foods, which can be a boon for your health.
  • Get quality sleep: Increased levels of androgens can affect your airway, and hormonal fluctuations can also disrupt the circadian rhythm. If you’re getting seven to nine hours of sleep each night but still feeling groggy and sluggish, talk with a healthcare provider. They may suggest being tested for sleep apnea, which is common with PCOS, and can sabotage weight loss.
  • Keep your stress levels low: Stress releases the hormone cortisol, which can contribute to PCOS weight gain. Take time for self-care, meditate, journal, or talk with a friend or mental health professional. You don’t have to bear the stress alone.
  • Exercise: There’s no best or worst way to exercise for PCOS. Just focus on moving your body more. Take walks. Try resistance bands or squats. “A good exercise program is whatever you enjoy,” Dr. Thigpen advises. “Consistent moving is what matters.” Aim for 150 minutes of cardio a week and two to three sessions of strength training.
  • Manage medications: Treatments for PCOS, like metformin (Glucophage®), can support weight loss by addressing insulin resistance. If you have PCOS and obesity, anti-obesity medications may be an option as well.

Talk with your healthcare provider for personalized advice about managing PCOS belly. And remember that it’s not about giving up the hunt for a bathing suit with tummy control or the awkwardness of shimmying into shapewear. It’s about managing your health — and helping your body feel like yours again.