PCOS — or polycystic ovary syndrome — is an endocrine (hormonal) condition that comes with a plethora of unwelcome symptoms. Specifically, PCOS occurs when the body’s ovaries create a higher-than-normal level of hormones called androgens. From fertility problems to irregular periods, to headaches and pelvic pain, to excess body hair, anyone living with PCOS knows that the condition is certainly not a walk in the park. One of the side effects you may have heard of is “PCOS belly."

But what exactly is PCOS belly, and what differentiates it from other types of weight gain?

woman grabbing the rolls of her pcos belly

PCOS and weight gain: What's the connection?

To put it simply, the term PCOS belly refers to excess weight in the belly area. Those living with PCOS often experience abdominal weight gain independent of the rest of their body. People with PCOS belly will have higher fat deposits in the belly area, while the rest of their body remains the same as their “normal." This is not to say that any one body is “normal” vs. “abnormal," but rather, if you suspect you may have PCOS and also find that you’re experiencing a recent bout of weight gain solely in your abdominal area, PCOS may be the culprit.

How do know if I have “PCOS belly”?

Cordelia Nwankwo, MD, FACOG tells us, “The term PCOS belly refers to a pattern of fat distribution where fat accumulates in the abdomen. The increased abdominal weight gain is out of proportion with the rest of the body.” PCOS belly is just one of many PCOS symptoms, and not all people with PCOS experience the condition in the same ways. You can have PCOS and not have the telltale “PCOS belly." Other symptoms to look out for include:

  • Irregular periods

  • Ovarian cysts

  • Abnormal body hair growth, primarily on the chest, stomach, and back

  • An increase in acne or oily skin

  • Hair loss, primarily thinning of the hair that affects the hairline and crown of the head

  • Infertility 

  • Skin tags on the neck or armpits

  • Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts

What causes PCOS belly? 

“The accumulation of visceral fat in the abdomen in PCOS patients has been linked to insulin resistance," says Dr. Nwankwo. Insulin is an essential hormone you may most often hear about in connection with diabetes. Its purpose is to turn food into energy and help your body to control blood sugar levels. Many folks living with PCOS have insulin resistance, meaning the body does not use and manage this insulin well. Obesity can also increase insulin levels, making the PCOS belly symptom a vicious cycle for those living with polycystic ovary syndrome.

woman evaluating the size of her belly

I have PCOS belly: What should I do about it?

When it comes to PCOS belly, “Diet and lifestyle modifications are going to be very important, especially because of the association with insulin resistance," advises Dr. Nwankwo. “Specifically, try to stick to a diet higher in protein and fiber, and lower in simple carbs and processed foods. A lower inflammatory diet can be helpful."

With insulin resistance affecting 50% to 75% of people with PCOS, a focus on diet and lifestyle changes is vitally important in managing your health. The Mediterranean diet is a common “anti-inflammatory” lifestyle approach to food, often recommended by dieticians for folks suffering from PCOS. Studies show that following a Mediterranean diet can lead to a reduction of systemic inflammation, which helps in the prevention of diseases linked to inflammation. These include cardiovascular disease, metabolic syndrome, and type 2 diabetes. 

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So what does the Mediterranean diet entail? Basically, it’s a way of eating that emphasizes plant-based foods and healthy fats. Think along the lines of: 

  • Lots of vegetables, fruit, beans, lentils and nuts

  • Lots of whole grains, i.e. whole-wheat bread and brown rice

  • Extra virgin olive oil as a source of healthy fats

  • Fish, especially fish rich in omega-3 fatty acids.

  • A moderate amount of cheese and yogurt.

  • Little to no sweets, red meat, sugary drinks, butter, saturated fat, trans fat, or highly processed foods

Exercise and lifestyle modifications are also important when it comes to PCOS. Adding in a routine of moderate workouts can be beneficial. And remember, you don’t need a fancy gym membership or a pricey pilates or yoga class to get a workout in — brisk walking, jogging, cycling, and swimming are all great options.

woman jogging

If you find yourself experiencing the symptoms of PCOS, including PCOS belly, it warrants a conversation with your healthcare provider. While there’s no single test to diagnose PCOS, a physical exam, ultrasound, and blood tests can help to get patients the diagnostic answers they’re looking for. Whether or not you’re living with PCOS, diet, and lifestyle are important factors contributing to your overall health and longevity.

Lindsey Williams is a library worker and writer who lives in Arizona with her daughter, husband, and their dog, Peaches.