Polycystic ovary syndrome (PCOS) is the most common endocrine disease among women, affecting 6% to 12% of all women of reproductive age. It is also the most common cause of infertility among women.
Common symptoms include insulin resistance, diabetes, reproductive hormone imbalance, missed periods, infertility, and weight gain.
Another widespread symptom is PCOS belly.
PCOS belly is characterized by an apple shape with a prominent fat pad around the middle of the waist.
There are likely multiple causes, mostly related to excess male hormones and other metabolic imbalances. It does not occur in everyone with PCOS, but if you’re overweight, you are likely to develop a PCOS belly as part of your symptoms.
This guide goes over what a PCOS belly looks like, what causes it, and how you can deal with it. The most common questions women have about this common symptom will also be answered to give you a better chance of reducing its impact on your life.
Take Control of PCOS by Partnering With a Dietitian
90% of Zaya Care patients pay $0 for one-on-one counseling with a Registered Dietitan
Women’s bodies come in a variety of shapes and sizes. When they put on weight, fat rarely deposits uniformly all over the body; instead, it will settle predominantly around the waist, hips, or thighs, leading to various standardized body shapes.
Women are naturally pear-shaped, apple-shaped, triangular, or rectangular, depending on the sizes of their bones and where fat deposits. A few women have that classic hourglass figure. Some of your shape is considered genetic, while the rest depends on your hormones.
Women with PCOS belly often have an apple-shaped stomach and prominent fat around the middle of the waste.
Doctors can measure your hips and waist to determine your risk for PCOS. If you have a measuring tape, you can do it yourself at home. Measure in inches or centimeters and divide the waist circumference by the hip circumference to get a ratio.
Studies show that a waist-hip ratio of more than 0.87 often predicts an increased risk of PCOS. It doesn’t prove you have the disorder but might indicate that you need further testing. A high waist-hip ratio often demonstrates the presence of a PCOS belly.
If you want professional help managing PCOS, we can match you with a PCOS dietitian who accepts your insurance. 90% of Zaya Care patients pay $0 for one-on-one nutritional counseling with our Registered Dietitians.
What causes PCOS belly?
PCOS belly is a sign of increased fat deposition around the waist, making your waist circumference measurement higher than it should be. While healthy women tend to have excess adipose tissue compared to men, the location is more often in the breasts, hips, or thighs. This is not the case in women who have PCOS.
When fatty tissue builds up around the waist and internal organs, it is often the result of a particular hormonal pattern. If the ratio of male to female hormones in the body is greater than normal, as it is with PCOS, this type of centrally located fat increases.
Inflammation and insulin resistance (also symptoms of PCOS) contribute to the deposition of fatty tissue in regions around the waist, leading to a greater risk for heart disease and diabetes.
What are the risks?
We now know that where you carry your excess body fat matters. In PCOS, most of the excess body fat is around your middle. This type of body fat is linked to a higher risk of several cardiometabolic and reproductive outcomes:
High blood pressure. The more you weigh, the greater your chance of developing high blood pressure as your heart works harder. Central obesity, meaning extra fat in the abdominal area, is particularly linked to this problem even more than just being overweight.
High cholesterol and triglycerides. Central obesity is more likely to cause high triglycerides by itself. If you have high cholesterol for hereditary reasons, the combination can cause greater complications of high cholesterol, such as heart disease. Luckily, there are foods you can eat to lower cholesterol and other lifestyle modifications that can help.
Insulin resistance. Too much belly fat means you have a risk of higher insulin levels and resistance to the insulin your body is making. This can progress to the development of type 2 diabetes and its many complications.
High levels of inflammation. Many factors related to excess belly fat mean your body is inflamed. The inflammation causes many side effects, including fatigue, mental depression, and a higher risk of heart-related complications.
Infertility and missed periods. Excess body fat, ovarian cysts, high male hormone levels, and inflammation together contribute to the loss of female fertility. High male hormone levels inhibit the maturation of the female eggs, which become cysts rather than mature eggs. Side note: you can learn how to develop a diet that can help with PCOS fertility issues here.
Certain cancers. Because women with PCOS bellies do not ovulate as much as other women, the endometrium doesn’t shed completely each month. The result is a higher risk of excess endometrial lining and a greater risk of endometrial cancers.
Is PCOS belly or excess abdominal fat inevitable and unchanging? Not completely. You can manage this condition and reduce your risk factors for complications simply by using these strategies:
Eat well for weight loss or maintenance. A healthy diet that produces just a 6% to 7% weight loss can improve your symptoms and reduce belly fat. The way to lose this type of weight is to follow a PCOS diet—eat more foods like this:
Whole fruits
Vegetables of any kind except starchy ones like potatoes
Whole grains that have plenty of fiber (whole-grain bread, pasta, and brown rice)
Lean meats (poultry and pork tend to be leaner if you choose non-processed meat)
Fish
Healthy fats (avocadoes, or nuts and seeds in small amounts).
Avoid foods that are known to promote weight gain. Like with most diets, there are always foods you should avoid for managing PCOS belly, including:
Processed foods from the store (pizza, cakes, crackers, and prepared meals)
Baked goods (many are high in sugar and fat without redeeming nutrients)
Many women ask: is the keto diet good for PCOS? There is evidence that it is, but it’s important to consider the pros and cons of this kind of specialized diet.
Calculate your caloric needs. You can calculate your caloric needs by measuring your height and weight. Then think about your desired weight, which should be about 5% to 10% less than you weigh now. Then use a calorie calculator to calculate your caloric need. When it asks for your weight, put in your height, desired weight, and age. It will calculate your caloric need. Then use that number to determine how to achieve that caloric intake using healthy foods.
Eliminate alcohol intake.Alcohol has no nutrients and often many calories. If you drink beer or drinks with added liquids (juices or soda), the calories and carb intake add up. You may drink occasionally but don’t make it a daily habit.
Get regular exercise.Regular exercise accelerates weight loss and is great for heart health. Strength training improves metabolism by adding muscles. This can include weightlifting or other muscle-building activity. High-intensity interval training (HIIT) involves running, cycling, or other fast-paced activities that get your heart rate around 80% of your maximum for your age for a brief five-to-ten-minute period. Once you are tired out, you lessen your efforts to reduce your heart rate before going back to a higher exercise interval. This pattern allows you to push yourself for longer without tiring. NOTE: Simply targeting your abs by doing sit-ups or other ab exercises does not target belly fat and doesn’t burn many calories.
Practice good sleep hygiene. Lack of sleep changes your metabolism and affects your appetite. This combination promotes weight gain. Get seven to nine hours of sleep per night to make sure you optimize your metabolism for weight loss or maintenance.
Reduce stress.Stress promotes the release of cortisol. Cortisol increases your blood sugar and promotes insulin release to enhance abdominal fat composition. You can improve your ability to lose weight and improve your body composition if you do what you can to feel less stressed.
Limit caffeine intake. Caffeine by itself isn’t harmful in small amounts (a cup of coffee per day is fine). However, high doses of caffeine (above 2-3 cups per day) are linked to increased perception of stress, higher cortisol levels, and increased belly fat.
A PCOS nutritionist can help reduce your PCOS belly and risk for complications by understanding your unique issues and applying the appropriate strategies. PCOS nutritionists are trained in nutrition and have years of practice teaching women how to lose weight with PCOS to achieve better health.
A PCOS nutritionist will ask you about your health and wellness goals and study your current diet. They will help you apply strategies to reduce abdominal fat by planning a diet appropriate to your unique needs.
Once you are on your way toward better health, your nutritionist can keep you on the right path by adjusting your diet and exercise recommendations so you can maintain the type of health and appearance you want.
Take Control of PCOS by Partnering With a Dietitian
90% of Zaya Care patients pay $0 for one-on-one counseling with a Registered Dietitan
Does PCOS cause a big belly or extra belly fat? PCOS is often linked to increased levels of abdominal fat, giving the appearance of having a big belly. PCOS causes a variety of hormonal changes that predispose women toward having their excess body fat deposited in the abdomen (including around the internal organs) rather than on the hips or thighs.
What body shape does PCOS cause? In PCOS, elevated levels of male hormones and insulin resistance cause body fat to collect around the waist and internal organs. This often leads to an apple-shaped body type in which the ratio of the waist to hip circumference is greater than 0.87.
How can I reduce my PCOS belly? Your hormones in PCOS contribute to higher levels of abdominal fat. Fortunately, you can reduce belly fat by sleeping better, reducing your caloric intake, exercising, and lessening stress. You do not need to lose much weight (about 5% to 10% of your current weight) to begin to see benefits in your health. You will often alter this pattern of fat deposition around the waist as well.
Will abdominal exercises help? Abdominal exercises will never sculpt your abdomen. Sit-ups may strengthen your abdominal muscles and might burn calories, but they will do nothing to remove abdominal fat. No exercise can cause a localized reduction in body fat.
Why do women with PCOS gain weight around the middle? Insulin resistance and a pattern of male hormone dominance seem to trigger the deposition of fat around the middle when weight gain from PCOS occurs. Once you have insulin resistance and belly fat, the pattern is sustained by the inflammation that happens with excess fatty tissue.
Can I improve my symptoms with diet and exercise? PCOS symptoms—including increased abdominal fat—can be improved by eating a healthy diet and engaging in regular exercise. Once you have less body fat and reduced levels of inflammation, you will begin to feel better and have fewer PCOS symptoms.
Can thin women have PCOS? PCOS is more common among overweight or obese women; however, you may still have PCOS if you’re thin. Many women who have a normal body mass index still have a higher waist-to-hip ratio and have an apple-shaped figure.
Is it caused by stress? PCOS belly is not caused by stress; however, stress will often worsen your symptoms. This is because stress causes a release in your blood cortisol levels. Cortisol also causes increased deposition of fat around the waist, doubling your chances of having PCOS belly if you already have PCOS.
Christine Traxler MD is a family physician, lifelong writer, and author with a special interest in mental health, women’s healthcare, and the physical after-effects of psychological trauma. As a contributing writer and editor for numerous organizations, she brings a holistic focus to her work that emphasizes healing and wellness through daily self-care, connecting with others, and setting stepwise goals toward achieving more balanced and authentic lives.
