There are a myriad of symptoms associated with polycystic ovary syndrome (PCOS), including irregular periods, acne, excess hair and weight gain. But PCOS belly is the newly-termed side-effect of the condition that's currently got everyone talking.
There are over 50 million views on 'PCOS belly' videos on TikTok, while there are breakout searches for questions relating to PCOS belly on Google.
Given PCOS impacts the ovaries and reproductive organs, it's perhaps no surprise that the condition can impact how our stomachs feel and look. And with a Human Reproductive Update journal study finding that between 20-86% of women with PCOS having 'PCOS belly', we've turned to experts to explain what's really going on with PCOS belly.
What is PCOS belly?
''PCOS belly' refers to the excess abdominal fat that often accumulates in women with PCOS,' says Valentina Milanova, a women's health expert and founder of leading gynaecological health company Daye.
Studies show that people with PCOS are more likely to maintain fat around their central areas than people without the condition. One 2018 paper found that women with PCOS had around 17% more of both subcutaneous abdominal fat (the fat you can see and feel on your stomach) and visceral abdominal fat (the fat that is found deeper in your organs).
While online, PCOS belly is focused on what the belly looks like, our health is about so much more than aesthetics. In the above study, non-obese people with PCOS were still found to have higher levels of visceral fat around their central organs than non-obsese people without PCOS.
What causes PCOS belly?
'PCOS belly occurs due to the hormonal imbalances characteristic of PCOS, particularly insulin resistance and elevated androgen levels,' explains Milanova. 'Insulin resistance causes higher insulin levels, which stimulate the ovaries to produce more androgens (male hormones like testosterone). These androgens promote fat storage, especially in the abdominal area. The resulting weight gain further exacerbates insulin resistance, creating a vicious cycle. Insulin resistance is a common feature in PCOS patients, but not in all.'
What does PCOS belly look like?
'PCOS patients commonly hold fat around the belly area, even in women who are young and lean,' says Ms Tania Adib, a consultant gynaecologist at The Medical Chambers Kensington and The Lister Hospital London. In that way, the fat may seem unevenly distributed, with an unusual amount of fat around the stomach compared to your limbs and other areas of the body.
'A PCOS belly can result in a protruding or "apple-shaped" appearance. It often feels firm and solid to the touch due to increased visceral fat surrounding the internal organs,' explains Milanova. 'This differs from regular belly fat, which is more evenly distributed and soft. It's also distinct from bloating, which involves temporary abdominal distension rather than fat gain. Even lean women with PCOS may notice excess belly fat compared to the rest of their body.'
Of course, you won't have PCOS belly without PCOS, and a larger or harder belly isn't a diagnostic tool. 'While abdominal weight gain is common in PCOS, it's not a definitive sign,' explains Milanova.
If you're worried you may have the condition, then this is what you need to know: 'To diagnose PCOS, doctors look for at least two of the following: irregular periods, high androgen levels and polycystic ovaries on ultrasound. Other telltale symptoms include excess facial or body hair, hair loss and thinning scalp hair, acne, and difficulty getting pregnant. However, not all PCOS patients experience these symptoms and PCOS is not an infertility diagnosis.'
Abid says: 'I would also typically check fasting insulin, long-term sugar, and sugar levels on a blood test to confirm PCOS.'
These symptoms can also align with other gynaecological health conditions, which can make fighting for the right diagnosis hard. 'Conditions like endometriosis can also involve pelvic pain and heavy periods but don't cause excess androgens or change body fat distribution the way PCOS does. Diagnosing PCOS versus other gynaecological conditions involves a combination of clinical evaluation, symptom assessment, and diagnostic tests. Another key indicator of PCOS is irregular menstrual cycles.'
Is PCOS belly bad?
Let's clear one thing up: there is nothing wrong with having a round stomach. The issue with PCOS belly is that excess abdominal tissue - especially visceral abdominal tissue - can pose a health risk, as there are vital organs in this area. 'Excess abdominal fat is related to metabolic syndrome, high cholesterol and heart disease,' says Abid. And remember that, because visceral fat is deep, it can impact lean and large people alike.
Milanova adds: 'PCOS belly is strongly linked to insulin resistance, type 2 diabetes, high blood pressure, heart disease and fertility issues as fat cells produce inflammatory molecules that worsen PCOS symptoms and metabolic problems.' In a Nature journal article, experts report that waist size can be a more reliable indicator of health risk than the flawed BMI system, noting that the latter 'is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults'.
'Managing abdominal fat is crucial for reducing PCOS complications and supporting overall health,' says Milanova. 'It's also really important that PCOS patients take additional care to get screened for and mitigate the risk of pre-diabetes, diabetes and cardiovascular disease as they are at higher risk of developing these conditions.'
How to get rid of PCOS belly?
'It is important to note that weight loss is not the only solution for PCOS symptoms, and any weight loss conversations had with patients need to be approached with the utmost care,' says Milanova. And research supports this: a 2023 Nutrition journal study found that modifying diet without a caloric deficit improved cardiometabolic risk factors in women with PCOS, proving that diets and weight loss aren't the only way to improve health and reduce visceral fat.
'Lifestyle changes are the foundation of PCOS management. Eating a balanced diet rich in fibre, protein, probiotic foods, and healthy fats helps regulate insulin, reduce inflammation and promote fat loss. Regular exercise, especially pilates and long walks, can improve body composition and insulin sensitivity,' adds Milanova. Abid agrees that lifestyle management is a great first step, too: 'Mmaxing on phytonutrients, vegetables and good quality protein is enormously important in PCOS,' she says. 'You may also want to take supplements: omega 3s, folate and inositol - which helps with insulin resistance - can be important for managing PCOS symptoms.'
And that's not all: 'Stress management techniques like yoga and meditation may help lower cortisol, a stress hormone that contributes to abdominal fat storage. Additionally, managing stress and ensuring adequate sleep can help regulate hormones that influence weight. Prescription medications, like metformin, can be prescribed to manage insulin responses and glucose spikes. And working with a doctor to address any underlying hormone imbalances is important,' says Milanova.
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