PCOS Awareness Month: Managing Weight, Symptoms, and Fertility

Polycystic ovary syndrome (PCOS) is essentially a hormonal imbalance in which the ovaries produce excess “male” hormones (androgens) that disrupt the normal reproductive cycle. This leads to symptoms like irregular menstrual periods, unpredictable or absent ovulation, and sometimes multiple small ovarian follicles or “cysts” (hence the name polycystic ovary syndrome). Women with PCOS often notice symptoms such as acne, thinning scalp hair, or extra hair growth on the face and body due to high androgen levels. PCOS is also closely linked to difficulties with weight and metabolism – between 40% and 80% of people with PCOS have overweight or obesity and often struggle to maintain a healthy weight. PCOS doesn’t just affect reproductive health; it’s a whole-body condition that can raise the risk of issues like insulin resistance, type 2 diabetes, and heart disease if not managed. PCOS is also one of the most common causes of female infertility. The hormonal imbalance prevents regular ovulation (release of eggs), so many women with PCOS have trouble getting pregnant. Even those who aren’t trying to conceive may not realize they have PCOS until they experience irregular cycles or unexplained weight gain. The condition is very common – by some estimates, up to 1 in 10–7 women of reproductive age have PCOS.

Three key players that frequently come up in PCOS are weight, insulin resistance, and inflammation. These factors often form a vicious cycle that can worsen PCOS symptoms – but they’re also areas where nutrition and lifestyle changes make a big impact.

Insulin Resistance

Most people with PCOS have some degree of insulin resistance – meaning the body’s cells don’t respond well to insulin, a hormone that helps control blood sugar. When cells are insulin-resistant, the body pumps out more insulin to compensate, leading to high insulin levels. Elevated insulin can drive the ovaries to produce more androgens (male hormones). In short, excess insulin triggers excess androgen, which then worsens symptoms like irregular periods, acne, and unwanted hair growth. Over time, insulin resistance also contributes to higher blood sugar, weight gain, and increases the risk of developing type 2 diabetes.

Weight and PCOS

Many women with PCOS gain weight more easily, especially around the abdomen, and have difficulty losing it. High insulin levels promote fat storage, and PCOS-related hormone imbalances can slow metabolic rate – making weight loss challenging. Meanwhile, having overweight or obesity can further increase insulin resistance, creating a feedback loop. This combination can exacerbate PCOS symptoms.

The encouraging news is that even modest weight loss can significantly improve PCOS. Research shows losing as little as 5% of body weight can lead to marked improvements in symptoms and hormone balance. In fact, weight loss of 5–10% has been found to help regulate menstrual cycles, restore ovulation, and increase the chances of conceiving in women with PCOS. One analysis found that women who lost weight before fertility treatment had much better pregnancy success than those who went straight to medication. So, weight management is often a first-line strategy in PCOS care – not about achieving an “ideal” number on the scale, but about small, sustainable changes that improve health.

Chronic Inflammation

PCOS is also associated with a state of low-grade inflammation in the body. This isn’t the acute inflammation you’d get from a cut or infection, but a constant, mild elevation in inflammatory markers. Excess body fat (especially around the belly) can produce inflammatory chemicals, so being overweight can amplify inflammation. In turn, inflammation may worsen insulin resistance and cardiovascular risks.

Essentially, PCOS and obesity can create an “endless loop” with inflammation – PCOS increases the likelihood of weight gain, extra weight contributes to inflammation, and inflammation can further aggravate PCOS. The goal is to break this loop. Diets rich in anti-inflammatory foods (like fruits, vegetables, and omega-3 fats) and weight loss have been shown to reduce inflammation and even improve menstrual regularity. By calming this chronic inflammation through healthy eating, you’re also helping to improve how your body responds to insulin and hormones.

Nutrition Approaches for PCOS

When it comes to how to eat for PCOS, there isn’t a single “magic” diet – but a few nutritional approaches have consistently shown benefits. The best diet is one you can stick with long-term, but it’s worth looking at three popular strategies often recommended for PCOS: Low Glycemic Index (GI) diets, the Mediterranean diet, and the Ketogenic diet. Each of these emphasizes a different aspect of eating, and all have some scientific support for improving PCOS markers (like weight, insulin levels, or fertility). Let’s break down each approach, along with its pros and cons.

1. Low Glycemic Index (Low-GI) Diet

• What it is: Focus on slow-digesting carbs (whole grains, legumes, fruit, veggies).

• Why it helps: Keeps blood sugar and insulin stable, improving ovulation and reducing androgen levels. One study found 25% of women on a low-GI plan resumed ovulation vs. 7% on a standard diet.

• Pros: Balanced, sustainable, improves energy and fertility.

• Cons: Requires learning which foods are low vs. high GI.

2. Mediterranean Diet

• What it is: Veggies, fruits, olive oil, fish, legumes, nuts; minimal processed foods.

• Why it helps: Anti-inflammatory and heart-healthy. Improves insulin sensitivity, lowers inflammation, and may improve cycle regularity.

• Pros: Enjoyable, nutrient-dense, supports long-term health.

• Cons: Not strictly for weight loss; results may be gradual.

3. Ketogenic (Keto) Diet

• What it is: Very low-carb, high-fat; induces ketosis.

• Why it helps: Lowers insulin and testosterone quickly; some studies show significant weight loss and cycle improvement.

• Pros: Fast results, reduced cravings, hormone improvements.

• Cons: Restrictive, hard to sustain, potential nutrient gaps, “keto flu,” possible cholesterol rise. Best short-term and medically supervised.

These are just a few considerations; there are SO MANY different approaches to nutrition care, but that is why working with a Registered Dietitian that can review your lifestyle, preferences, medical and social history, food relationship and more is SO IMPORTANT. PCOS symptoms and struggle are individualized, and your nutrition plan should be too.

Supplements to Consider

In addition to overall diet patterns, certain nutritional supplements have shown promise in managing PCOS symptoms. While they’re not magic pills, these supplements can support the body in areas where women with PCOS often have imbalances or deficiencies. Always talk with a healthcare provider before starting supplements, but here are a few common supplements in PCOS management:

• Inositol: Improves insulin sensitivity, lowers testosterone, and supports ovulation. Well-studied and safe.

• Vitamin D: Deficiency is common in PCOS; supplementation improves insulin, cycles, and fertility.

• Omega-3s: Reduce inflammation, improve cholesterol and possibly androgen levels.

• Probiotics: It is known in research that people with PCOS have poorer gut microbiome.

• Several others depending on your symptoms!

Small, consistent steps – like swapping refined carbs for fiber-rich foods or adding fish and olive oil – can make a big difference. PCOS may not be curable, but with the right nutrition, you can take back control of your health and fertility. Want to learn more about preconception nutrition? Check out a blog where Rachel Hutto MS, RD, LD is featured here. Ready to take the next steps in your journey? Book an appointment today!